DISCLAIMER:Video will be taken at this clinic and potentially used inProject ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow

Project ECHO to use this photo and/or video. If you don’t want your photo taken, please let us know. Thank you!

ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

Steven A. Shane, M.D., M.S.sshane@chanevada.org

Program Director,Community Health Alliance Healthy Weight Program

.

.

Obesity is the number 1 health problem in Nevada. Preventative efforts are too few and fragmented. A cultural shift is required. Stakeholders need to work together! The Let’s Go! Program can bring like-minded efforts

under one “umbrella” to work together towards a healthier community.

.

.

~100,000 children in Washoe County (2015 Census). ~34,600 have unhealthy weight (~18,000 are obese). CHA: ~ 38% overweight/obese (< 6 yr :25%, ≥ 6 yr :40 –

48%) ≥ 50% of obese school-aged children will become obese

adults (40% of US adults). Obese adults have an estimated additional medical cost of

$2741 annually. Costs are similar to those associated with smoking. 1/3 will develop diabetes.

21% of all medical costs - $190 - $250 billion annually. By 2030, medical costs could rise by $48 - $60 billion a year!

.

.

Nationally-recognized, comprehensive state-wide obesity prevention program in Maine that was initiated in 2006 by Maine Health with corporate funding.

Healthy behaviors are increasing.

Obesity rates are leveling off and may be trending down.

Programing for adults rolled out in 2017.

.

.

“Ready-to-use” materials (Toolkits).

Simple, consistent messaging.

Evidenced-based-supported by AAP.

Materials are in English & Spanish – free PDFs!

Time-tested framework for community collaboration.

Co-branding . Training is available.

.

.

Agency for Healthcare Research and Quality 2013:Interventions in schools with community and/or home components had the strongest evidence of contributing to obesity prevention.

.

.

.

.

.

.

.

.

.

.

.

.

https://mainehealth.org/lets-go

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Implementation of 5210 Let’s Go! Program messaging for all providers: Toolkits, posters, Healthy Habits Questionnaires

Healthy Weight Clinic (BMI ≥ 85%). 6 class curriculum and one-on-one appointments over 6

months Team approach with physician, dietician and

psychologist, promotora Link patients with community resources.

FBNN “Smart Shopper” Classes (SNAP Eating Smart-Being Active)

.

.

.

.

.

.

.

.

.

.

Group and individual appointments 6 classes of 10 - 15 patients with parents and sibs Assess for associated medical conditions, refer if

needed. Use Healthy Living Plan based on 5210 and Healthy

Habits Questionnaire. Develop community partnerships for services (e.g., gym

memberships, cooking classes, farmers markets). Fresh fruit and veggies from FBNN. Analysis of BMI, labs, and healthy behaviors to monitor

effectiveness.

Team with MD, RD, PhD, Promotora, LPN, MAs

.

.

.

.

.

.

.

.

Class completion - 13/19 (68%) had decreased or maintained the same BMI z – score

Program completion – 12/17 (71%) Individual appointment completion – 1/3 (33%) All who completed classes and/or program, improved at

least 1 or more 5210 behaviors, as well as other behaviors measured (e.g., junk food, fast food).

Majority improved 2 or more of the 4 metabolic tests measured (blood sugar, cholesterol, triglycerides, ALT).

.

.

Food Bank of Northern Nevada Kiwanis Bike Program ReThink Your Drink Nevada WIC Program High Sierra AHEC (WCSD) University of Nevada, Reno CSA & UNR Head Start Program

.

.

HWP Coordinator: 0.5 FTE HWC patient selection, compliance, & retention Maximize support & resources for HWC patients Resources & support for providers Community promotion and training

Training and marketing Let’s Go! Program training for developing effective

model for community promotion of childhood obesity prevention

Marketing and educational materials to facilitate healthy messaging in the community

.

.

Expand and improve our programming in CHA. Develop more partnerships to help promote and

facilitate healthy behaviors. Create back bone organization and expand the

“healthy messaging” beyond CHA into the community. WCSD Other healthcare providers/systems After - school programs Child care programs

.

.

Health care

Schools

Child care

Work place

After school

HWC

Obesityprevention Employee

wellness

CHA

Community

CHA HWP

.

.

Nutrition education for group classes

Topics covered

Obesity and Physiology

Healthy snacking/food labels/portion sizes

Division of responsibility/role modeling

Mindful eating/hidden sugars

Physical activity

Eating out/ School lunches

.

.

.

.

.

.

.

.

.

.

Education in the office

Provide easy and accessible tools in exam rooms

Displays in waiting areas

Videos for waiting rooms

.

.

.

.

Academy of Nutrition and Dietetics eatright.org/

Nourish interactivenourishinteractive.com/

Learning Zone Xpresslearningzonexpress.com/

Rethink Your Drink Nevadarethinkyourdrinknevada.com/

Nevada WICnevadawic.org/

Fruits and Veggies More Matters

fruitsandveggiesmorematters.org/

.

.

Obesity is associated with many negative psychosocial outcomes. Teasing (family and peers) / Bullying Impaired/restricted participation in activities Depression and Anxiety

Mental Health outcomes are significantly impacted during middle school age (12-14)*

*Swallen et al. 2005

.

.

Typically, family patterns of eating and activity contribute to obesity.

Poor compliance between parents and children/adolescents will impair any intervention.

Shaming and singling out one family member typically fails to create long standing changes.

Anxiety and depression (and boredom) can also play a role (binge eating, mindless eating, eating as escape)

.

.

Kids have to be able to follow directions (address family dynamics)

Family has to be on board with systemic changes. Family may have to be educated on shaming. Address bullying if present. Address depression/anxiety or other mental health

concerns.

.

.

Set small and achievable goals (behavioral momentum)

Focus on healthy habits rather than results. Set them up to handle setbacks. Adapt changes to their lifestyle.

.

.

Mindful eating Smiling Mind is a free mobile app co-developed by

psychologists and health professionals that helps individuals learn mindfulness meditation. Smiling Mind has a 10-week program for different age groups (7-9, 10-12, 13-15, 16-18, adults). The introductory session at the start of each week explored breath, sounds, tastes, etc. The user is advised to practice mindfulness and relevant take-home activities with the assistance of the app.

Mobile Application Rating Scale (MARS) Score: 3.7/5.0

.

.

Pre-cut veggies and fruits and have a crisper drawer that kids can have free access to.

Trade activity (exercise) for screen time. Less time available for screens and more effort to earn them.

Work on small achievable goals one at a time until it is a habit, then add another.

.

.