As we know, obesity now affects over 20% of children in the United States, and while there are proven interventions to address it, many children still lack access to these treatments. Yale researchers recently explored the cost-effectiveness of one such intervention and examined the challenges and successes in implementing another. Their goal was to identify ways to increase access to effective pediatric obesity treatments. The studies were published in the journal Obesity.
Why do we need these studies?
These studies come at a crucial time. Experts from Yale, in collaboration with national medical organizations, are backing a proposal being considered by the Centers for Medicare and Medicaid Services. This proposal suggests a new billing code that could allow health insurance to cover intensive behavioral and lifestyle treatments for childhood obesity. Such a change would encourage the adoption of these programs and improve access, according to the researchers.
Previous research has shown that interventions providing comprehensive, family-focused nutrition and behavioral education with at least 26 contact hours over a three- to 12-month period are effective in treating childhood obesity. These programs have been recommended by the U.S. Preventative Service Task Force and the American Academy of Pediatrics.
Dr. Mona Sharifi, one of the study authors and an associate professor of pediatrics at Yale School of Medicine, said:
We have effective treatment options… But there are systemic barriers that limit access, and we need to address them urgently.
The first study findings
Cost is a recurring issue in healthcare programs, including obesity treatments. In the first study, Sharifi and her colleagues evaluated the costs associated with implementing the Healthy Weight Clinic intervention in federally qualified health centers from both healthcare and societal perspectives.
The Healthy Weight Clinic offers intensive behavioral and lifestyle treatment for children and adolescents with obesity or overweight. The program involves a team of pediatricians, dieticians and community health workers delivering care within primary care settings, where families are already engaged. The researchers focused on federally qualified health centers because they serve underserved communities disproportionately affected by obesity.
“This choice was intentional to reach communities that face higher obesity disparities,” Dr. Sharifi explained.
The researchers broke down the costs of the intervention, including personnel, materials, and family expenses like time, transportation, and childcare. They then used a model to simulate the impact on a sample of patients over 10 years, comparing those who participated in the Healthy Weight Clinic with those who did not.
The findings showed that if Healthy Weight Clinics were available in all federally qualified health centers over 10 years, they could reach 888,000 children with obesity or overweight and prevent 12,100 cases of obesity and 7,080 cases of severe obesity. The cost per child was estimated at $667, with $456 covered by the healthcare sector and $211 incurred by families. The reduction in obesity cases could save an estimated $14.6 million in healthcare costs over the same period.
Dr. Sharifi said:
It’s a relatively low-cost intervention that our team previously found to be effective… And scaling it up in federally qualified health centers could help reduce health disparities in underserved populations.
The second study findings
In the second study, the researchers examined another intervention by looking at the spread of a program called Smart Moves, which is based on Yale’s Bright Bodies program. Earlier research by Drs. Sharifi, Mary Savoye (the creator of Smart Moves), and others found Bright Bodies to be effective in improving health outcomes in children with obesity and overweight and more cost-effective than standard clinical care.
Between 2003 and 2018, the Smart Moves curriculum was introduced in over 30 sites across the U.S. The new study collected feedback from staff at those sites to identify what helped or hindered the program’s success.
Addressing funding instability
Local partnerships with schools and exercise facilities were key to successfully implementing Smart Moves by providing resources and creating demand for the program. However, funding instability was a major barrier, often preventing programs from being implemented or sustained.
According to Dr. Sharifi,
When a child breaks their arm, their family seeks care, and the clinic bills the insurance company. But this funding model doesn’t work as well for behavioral and lifestyle treatment programs. For example, Bright Bodies involves group visits with families and is led by a dietician, an exercise physiologist, and a social worker.
But insurance companies typically don’t reimburse these programs, even though Bright Bodies has proven to be more effective and cost-saving than usual care. Programs often rely on grants, which eventually run out, leaving communities without access to standard care.
To address this, several organizations, including the American Academy of Pediatrics, the American Academy of Family Physicians, and the CDC, have submitted a proposal for a new billing code. The Centers for Medicare and Medicaid Services will review this proposal in the coming months.
“If approved, it would open the door to more efficient funding for these treatments and give families better access to interventions,” Sharifi said. “In other areas like surgery, not reimbursing for standard care would be unheard of, but in pediatrics, children often get overlooked in health policy, and pediatricians are underpaid.”
Policy changes are needed to ensure that first-line treatments are available to families across the country, Sharifi emphasized.
“Expanding access to these treatments is a pressing need,” she said. “Denying equitable access to effective, low-cost treatment for children is simply unethical.”
What else could be done?
According to the World Economic Forum (and proven by research and statistics), policymakers are working to address harmful food marketing, particularly by restricting marketing to children, imposing taxes on sugary drinks, mandating clear nutrition labels, and limiting portion sizes.
Additionally, research indicates that digital health interventions, such as text messaging programs and digital therapeutics, show promise in supporting weight management and promoting healthy behaviors among children and adolescents.
Your responses and feedback are welcome!
Source: “Evaluating the benefits of and barriers to pediatric obesity programs,” Medical Xpress, 8/28/24
Source: “Childhood obesity — how do we tackle this worsening health issue?,” World Economic Forum, 8/30/24
Image by Vitolda Klein on Unsplash
