Insurer aims to help slim down kids

A childhood obesity program tested by Blue Cross and Blue Shield of North Carolina is rolling out nationwide by the insurers' sister firms.

The approach provides doctors with strategies for talking with youngsters about maintaining a healthy weight and getting adequate exercise. It's been used in North Carolina among many of the insurer's doctors since 2007 as part of a broader effort by the state's largest insurer to tackle rising obesity rates.

In North Carolina, a third of youngsters are obese or overweight, increasing their risk for developing diabetes, hypertension, heart disease and stroke. Type 2 diabetes, in particular, is often linked to excess weight caused by a fatty, high-calorie diet and too little exercise.

At one time, Type 2 diabetes nearly always occurred later in life. But that's changed. In recent years, Type 2 diabetes has increasingly been diagnosed in children. Nationally, 4 in 1,000 children have diabetes, and nearly a third of those cases are Type 2, according to an annual health survey.

For an insurer such as Blue Cross and Blue Shield of North Carolina, the mounting health problems associated with obesity are a huge expense. An economic analysis by RTI International put the medical costs of obesity nationwide at $147 billion a year — much of which includes the hospitalizations, treatments and therapies that insurance companies cover.

"When you look at a per-member, per-month basis, adults who are obese are 32 percent more expensive than a non-obese person," said Dr. Don Bradley, chief medical officer at the insurer. "An overweight person is 16 percent more expensive. When you consider that two-thirds of the population is either overweight or obese, that's quite a lot."

To tackle the problem, Blue Cross and Blue Shield of North Carolina helped develop a tool kit for doctors to launch interventions with children and their parents. The approach offers suggestions about healthy diets, regular exercise and less computer, video game and TV time. Specifically, doctors are urged to recommend eating five helpings of fruits and vegetables a day, and drinking no beverages with calories, including sweet tea, fruit juices and sodas.

Dr. Edie Bernosky, a pediatrician from Chapel Hill who helped pilot the insurance company's effort, said the information in the tool kits is easy to understand and helps put the problem in perspective. She said many children and parents are unaware of the serious health consequences of obesity — and the likelihood of severe problems occurring earlier in life.

The Blue Cross program provides doctors with an accessible definition of the body mass index, for example, to help frame the scope of the problem for children and their parents. The BMI is a calculation of weight and height, with anything over 25 considered overweight.

"We're talking about the BMI as almost a vital sign," Bernosky said. "When a child's BMI is really high, parents are aware of cardiovascular disease in adulthood and adult onset diabetes, but they don't make that connection of an elevated BMI in childhood leading to the same outcomes."

She said it's important to make those connections, and to change behaviors early.

"This is a national epidemic, and what we need to do is take measures and strategies from multiple directions," Bernosky said, noting that healthy foods should be available and affordable, and exercise should be promoted at schools and elsewhere. "It's useless to promote these concepts if we don't reinforce that and make it possible to achieve these goals."