Coverage improving for kids who are obese

SAN FRANCISCO – Parents of overweight and obese children face a heavy burden in navigating a complex health care system that does little to help them change their kids’ course. But a growing number of employers and health insurers are trying to make it easier to get such help.

Health insurer Humana Inc. and consulting firm Accenture are the latest companies to sign onto a pilot program that offers families with obese children health coverage for at least four follow-up visits with a pediatrician and four visits with a registered dietitian a year.

A handful of large employers such as PepsiCo, Mars and Owens Corning also are testing the benefit, with health insurer Aetna Inc. recruiting the latter two to participate. At the end of the project, analysts at Emory University will evaluate its effectiveness.

The initiative is the brainchild of the Alliance for a Healthier Generation, a New York-based joint venture between the American Heart Association and the William J. Clinton Foundation that aims to reduce childhood obesity.

“Childhood obesity is an epidemic,” said Ginny Ehrlich, executive director of the alliance. “There’s no single cause or single solution. We need everyone at the table to really solve this in this country.”

The group’s 1-year-old initiative has reached 1.5 million kids so far. Its goal is to make the benefit accessible to 6.2 million, or 25 percent, of the nation’s children and teenagers by 2012.

“Our goal here is simply to make access to the treatment more available,” said Tom Granatir, Chicago-based director of Humana’s public health initiatives. “That means doing some communications with the (parents) to try to encourage them to deal with the issue of obesity in the family and expanding our network to make sure we have access to more dietitians.”

Humana will offer the benefit to employees of the commonwealth of Kentucky starting in 2011, a move that will reach many as 47,000 children, he said, noting that in Kentucky, 37 percent of kids are carrying too much weight.

The prevalence of kids’ obesity has tripled since the 1970s, according to the Centers for Disease Control and Prevention. But its growth leveled off between 1999 and 2006, according to a study published online in the Journal of the American Medical Association last month.

Among children and teens age 2 through 19, 32 percent were at or above the 85th percentile of body mass index for their age in 2007-08, while 17 percent were at or above the 95th percentile, the study found. Overweight and obese kids are more likely to develop serious chronic diseases such as heart disease, high cholesterol, high blood pressure and Type 2 diabetes.

Earlier this month, first lady Michelle Obama launched a wide-ranging “Let’s Move” campaign aimed at curbing childhood obesity.

Parents of overweight kids need doctors and dietitians to communicate better about treatment progress, said Dr. Sandra Hassink, pediatrician at A.I. Dupont Hospital for Children in Wilmington, Del., and chair of the American Academy of Pediatrics Obesity Leadership Workgroup.

“Both pediatricians and dietitians want the ability to work as a team,” she said. “A coordinated approach is the approach we need.”

A dietitian can help families address such things as cultural biases that mistakenly equate kids’ corpulence with health, said Keith-Thomas Ayoob, a registered dietitian and associate professor of pediatrics at the Albert Einstein College of Medicine in New York.

“Education alone isn’t enough,” he said. “It’s part of the deal, but it’s education plus motivation plus troubleshooting plus reinforcement. You want to have good ongoing monitoring.”

Sometimes parents’ fear of a young child’s “food tantrum” at the end of a long day drives them to provide less healthful meals, Ayoob said. Sometimes the problems are more related to lack of physical activity.

“I like to tell people I want no child left on his behind,” Ayoob said. “Kids don’t need to go to a gym or lift weights. They just need to play.”

Troy Dees credits lessons learned in quarterly visits with a dietitian with helping his son Hunter, now 13, avoid insulin shots after he was found to be insulin-resistant at age 10.

“I know several people who have to take an insulin shot, and it’s not a pleasure cruise,” the elder Dees said, noting that getting his son to the point where he doesn’t need to be on diabetes medication is the next big goal.

Hunter, who is 6-foot-2, has been able to stabilize his weight at 230 pounds, and he participates in many sports, his father reports.

Dees, 50, of Atlantic Beach , N.C. , likened the dietitian visits to coaching and said he’s learned, too – he never knew that potatoes and white rice are considered a sugar, for example. As an adult, it’s been hard but necessary to model a different nutritional approach. “We’ve learned to control what we bring in the house, what’s offered and when we go out to eat we make … different choices.

“The whole family has to realize it takes a village. Everybody’s got to do it,” Dees said. “You can’t expect (Hunter) to do it and you’re sitting over here pigging out on Ho-Hos.”

Having the visits covered by his health insurer, Blue Cross Blue Shield of North Carolina, means he didn’t have to “second-guess” the decision to try counseling.

For families who have to pay the full cost out of pocket, Ayoob estimates a visit to a registered dietitian runs $60 to $150, depending on location and the amount of time involved.

Physical activity also factors into the equation, he said.

“I don’t want to get kids conditioned to the idea that all our pleasures have to be sedentary ones,” Ayoob said. “I’ve had parents who say, ‘If he’s at the beach, he loves the water and doesn’t think about eating all day.’ It’s because he’s found something he likes better. If they don’t have anything they like better they’re going to go back and forth to the kitchen.”