Healthy Habits - Changes for Life

Obesity is an epidemic in developed countries worldwide. In just three decades, we have witnessed a four fold increase in the prevalence of obesity among people of all ages, race and socioeconomic status. Despite the importance placed by the United States Armed Forces on high physical fitness standards, the obesity epidemic also afflicts its members and their families. Military dependents, a consistent and successful source of future military recruits, have not been protected from the epidemic of obesity. Trends toward an increasing prevalence of obesity have been demonstrated in the military dependent population at comparable rates to the population of adolescents at large. Shockingly, for the first time in history, the current generation’s life expectancy is predicted to be less than that of the previous generations. This finding is largely a result of obesity and its co morbidities. Obesity in childhood and adolescence is of particular concern, as adolescents with obesity almost always become obese adults. Despite these disturbing trends, obesity is often overlooked during routine pediatric medical visits; the “elephant in the room.“ This is especially true when the patient is being seen for a complaint unrelated to weight. Due to many barriers, including time constraints during the patient encounter and the difficult nature of lifestyle changes, effective therapies, particularly behavior modifications, are difficult to attain in the current clinical practice paradigm. Our team has developed an innovative approach to adolescent obesity management outside the typical clinical environment with the creation of a “Healthy Habits Clinic.” The premise of this clinic is to combine behavioral therapy and family involvement, both evidenced based factors essential for success in maintaining weight loss, with expert medical care of obesity and its comorbidities to provide an optimal "medical home" for obese adolescents. In a 10-session program, incorporating key components from the Department of Health and Human Services’ Body Works Program, we have incorporated patient- centered goal-setting, comprehensive medical evaluation, physical activity, nutritional education, and behavioral health skills in a group setting, involving both the patient and the family, for the ongoing management of adolescent obesity. The initial intake visit includes basic education, motivational goal setting and a comprehensive medical evaluation. Follow-up visits occur in our facility fitness center, outside the conventional medical setting, as physical activity, nutrition education, and behavioral modifications are achieved as a group. As expected, this Healthy Habits clinic offers improved, convenient and comprehensive care for our patients in their ongoing struggles against obesity, as an additional benefit, we also noted improvements in the diagnosis, screening, and follow-up of patients diagnosed with overweight or obesity in the pediatric clinic. Over a six-month period, patients were correctly labeled as obese 81% of the time (compared with only 69% prior to initiation of the clinic). Screening tests recommended for children with obesity by the American Academy of Pediatrics were obtained 65% of the time once the clinic was available (compared to only 46% of the time prior to the Healthy Habits Clinic). Finally, patients were asked to follow-up for a dedicated medical visit for obesity a striking 75% of the time once the clinic was available (compared with a previous follow-up recommendation of only 50%). Thus, the Healthy Habits Clinic, originally designed in the interest of enhanced comprehensive care for obese adolescents, resulted in additional improvements in provider recognition, screening, and follow-up for obesity. A dedicated clinic for obese adolescents affords general pediatricians and subspecialists the time and opportunity to address obesity concerns, identify individual risk factors and barriers, uncover existing co morbidities, and provide education and regular follow-up for patients and their families in a medical home environment. This intervention program strives to promote healthy lifestyle changes through improvements in knowledge, attitudes, and behaviors. As a result, many participants have shown improved metabolic profiles and stabilization or reduction of BMI. In only a short time at our facility, this innovative and exciting approach to obesity management forged a change in clinical practice of primary pediatrics. The Healthy Habits Clinic is a great model for a provider-initiated obesity medical home that could be applied in multiple clinical settings throughout the Department of Defense. Given that a curriculum and resource kit are already available, the investment of time and personnel to provide this level of care to military beneficiaries would not need to be overly cumbersome. The demand for this program in our own medical center has become so great, that we are making plans for provider training and program implementation at other local military treatment facilities to allow for easier patient access to care. Of major importance, targeting obesity in children and adolescents not only helps to address this disease before the advent of co morbidities, but provides the opportunity for all members of the family, who often also struggle with obesity, to benefit from education and lifestyle changes.
Moving forward we are exploring multiple ways to improve upon our Healthy Habits clinical model. Most importantly, the use of technology, including online resources and mobile devices, would allow patients to track their goals and behavioral changes, interact with each other as a source of support, post important educational and motivational information, and allow for day to day “coaching” on goal attainment. The current curriculum could be modified for use in a younger patient demographic with even more focus on family education and participation and could be incorporated into the well child care paradigm, working to prevent the problem rather than addressing it after the fact. The Healthy Habits clinic model has embraced evidence-based approaches to obesity management outside of the current clinical practice paradigm. We have started to see improvements in the diagnosis and evaluation of obesity, and look forward to continued success and positive change in the health of our patient population, future military recruits, and, over time, the armed forces as a whole. We continue to forge innovation and change in a population that can benefit from it the most—our children!

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