Primary care teams at HHC are set to adopt a standard approach to combat the daunting problem of obesity by making fitness goals and prevention counseling part of routine care for children and adults. Beginning this month, doctors, nurses and other medical providers will work to educate patients about appropriate weight and a healthy lifestyle as part of routine visits and encourage patients to set fitness and healthy eating goals before they become at risk of obesity.
“This is a pre-emptive strike to reach patients before they face the devastating complications that often come with obesity,” said Dr. David Stevens, Senior Director of the Office of Healthcare Improvement.
The anti-obesity initiative will standardize and coordinate care throughout all HHC hospitals, diagnostic and treatment centers and community clinics, with medical providers conveying the same message to all patients: healthy eating and exercise are essential to fighting obesity and illness. The initiative will be adopted among pediatricians and their patients this month, with primary care physicians for adults to follow.
In New York City, 58 percent of adults and 40 percent of children are overweight or obese. The obesity epidemic strikes hardest in communities already suffering from health and economic disparities, particularly black, Latino and low-income communities where the rate of overweight and obesity reaches 70 percent in some neighborhoods.
“The problem exists nationally and in New York City in every ethnic group – there seems to be nobody that’s protected against the obesity epidemic and its ill health effects,” Dr. Stevens said. “We’re seeing Type 2 diabetes in kids. We used to call it adult onset diabetes – it’s not an adult disease anymore. And that’s because of the obesity epidemic.”
The onset of diabetes in younger patients will lead to the onset of other illnesses at a younger age, too, said Dr. Stevens. In addition to diabetes, children and adults who are overweight also are at increased risk for heart disease, stroke, high blood pressure, arthritis and cancer.
“We’ve got to do everything we can to prevent obesity and to help patients who are overweight and obese manage their weight loss,” Dr. Stevens said. The new primary care practices will follow a four-stage approach with patients, Dr. Stevens said. Stage 1 provides universal screening and recommendations for all patients, while Stages 2 to 4 build on existing practices to assist overweight children and adult patients to reduce their weight and improve their health.
Stage 1 – Universal screening and recommendations will be provided for every patient. Healthcare providers will:
- Record height, weight and BMI in electronic medical record.
- Discuss healthy lifestyle with all patients, since eating healthy and getting exercise are necessary to maintain health for all.
- Discuss the widely adopted 5-2-1-0 rule for children: 5 fruits and vegetables a day, 2 hours or less of screen time (TV and video games), 1 hour of physical activity and 0 sugary drinks.
- Discuss the food plate recommended by the city Health Department and the federal government, which provides a visual depiction of a healthy meal: half a plate of fruits and vegetables, one-fourth protein and one-fourth starch, and a serving of low-fat milk or water.
For overweight children and adults with increasing levels of need or risk, such as diabetes or high blood pressure:
Stage 2 --Intensive counseling and weight loss management with a healthcare provider. This could involve having the patient keep a daily food and exercise diary, recording what they eat and their exercise or physical activity. Providers will help patients set realistic goals for weight control and a healthy lifestyle.
Stage 3 – Support group sessions to help patients connect with others who share similar goals. These sessions will include medical monitoring, goal-setting and exercise.
Stage 4 -- Ensuring the proper referral to a sub-specialty, such as an endocrinologist, for further evaluation and management of any existing chronic diseases.
The approach follows HHC’s patient centered medical home model of care, which features a physician-led team-based approach to healthcare and replaces episodic care based on illness with a coordinated care management process that promotes long-term health and healing, Dr. Stevens said. Patients work with their primary care physicians, nurses, patient care associates, dietitians and specialists when needed.
All 11 HHC hospitals and six large community health centers have received medical home designation from the National Committee for Quality Assurance (NCQA) for delivering accessible, comprehensive and family-centered primary care to New Yorkers that aims to reduce avoidable healthcare costs over time. HHC physicians care for a primary care population of more than 477,000 adult and pediatric patients.
As part of the initiative, HHC has dedicated its annual Take Care New York campaign this year to fighting obesity through its "Commit to Be Fit” campaign.