With obesity front and center as public enemy number one -- at least in most media coverage of child health issues -- it's amazing how hard it can be to implement a weight management program to help guide children into a healthy lifestyle. The problem of course is money. Insurance isn't paying for obesity prevention or obesity management efforts, and few hospitals have the resources to feed money into a program that seems "optional" and is almost certain to lose money.
At Children's Hospital of the King's Daughters in Norfolk, VA, Barbara (Babs) Benson took it upon herself to put together a low-cost weight management program back in 2001. Her strategy for keeping costs low has been to do most of the work herself on a 30-hour-a-week salary, and to borrow everyone else as needed from other programs in the hospital.
She spends a lot of her time and energy to network, network, network. It's been her key to succeeding and growing the program. She serves on community boards related to children's health, volunteers through her program role to help at YMCA events, nurtures relationships with local media, and anything else she can think of to build mutually supportive relationships within the community. She has established herself -- and her program -- as community experts on child health and weight management, and that has created a lot of unexpected opportunities.
Babs teaches the 10-week weight management program to children ages 8-11 in sessions twice a week -- one lifestyle class and one exercise class -- and parents are required to attend. Getting parents involved has been one of the most successful aspects of the program, because it helps teach the entire family about better health and helps children see their parents are invested in improving their lives; the parents often lose weight, too.
Approximately 900 children have participated in the program since it started in 2001. The program has an annual budget of ~$100,000, which it meets. Thanks to early successes, Babs was able to bring on a half-time licensed clinical social worker to help her -- they are the only two paid staff.
Thirty-five percent of students are regular enrollees, charged the full $350 fee; 50 percent of enrollees are from families on Medicaid and are charged only $35; the remaining 15 percent of enrollees are charged an intermediate amount, based on need. Historically, about 75 percent of enrollees fulfill their financial obligation -- the 25 percent who default are never penalized (though this policy is not made public to students). Through experience, Babs learned it was necessary to charge Medicaid families some amount of money to ensure their commitment to the program -- when they offered it for free, more than half the students didn't show up.
Babs -- through her first-hand experience -- has a lot of solid advice to offer and a lot of proven success. The program has received a $60,000 grant to replicate itself in nearby Williamsburg, VA, and a $25,000 grant to fund a publication helping educate children on successful weight management. Babs says, "It's not about money, it's about doing what is right for our children."
The biggest drawback to the program has been its lack of any long-term metrics or follow-up studies to show the efficacy of the program. Short term, patients have seen small, but statistically significant improvements in the body mass index (BMI), but there is no evidence to show that they continue to make improvements after they complete the program. Babs has had trouble convincing people to return after the program for follow up assessments.
When the major focus of weight management education is enabling children to live healthier lifestyles, hopefully forestalling long-term health problems of diabetes, hypertension, joint injury, heart and liver disease, etc., there needs to be an evidence-based case that shows that education has a long-term effect on children's health. Because it will take evidence-based, long-term studies to make the case for other hospitals to implement similar programs and for insurance companies and government legislation to provide incentives for prevention and early intervention.
Listen to the audio recording. (MP3, 57 MB)
What do you think? What weight management initiatives exist in your area and what results have you seen that will help make the case for early intervention and prevention of childhood obesity?