Mayor Karl Dean gets moving with students at Lockeland Elementary Design Center during the launch of the NPT Reports: Children’s Health Crisis, which includes programming on the childhood obesity epidemic in Tennessee.

BlueCross BlueShield, NPT Step Up to the Plate

With two-thirds of the adult population clinically defined as overweight or obese, it certainly feels like America is losing the battle of the bulge. Of deepening concern is the trickle down effect as children’s eating habits and activity levels mirror those of their parents.

Scientists affiliated with the National Institutes of Health have predicted the current generation will actually have a shorter lifespan than that of their parents for the first time in history. In large part, this is due to the toll of obesity. In Tennessee, 39 percent of children are now overweight or obese, making the state among the worst in the nation for this key health indicator.

Where overweight and its comorbid conditions used to be the sole purview of clinicians, today more and more players are stepping in to join the fight. Two November events focused on the devastating impact of childhood obesity and sought sustainable solutions to address the issue. BlueCross BlueShield of Tennessee (BCBST) held a forum on childhood obesity bringing approximately 70 stakeholders from across the state to seek solutions, share success stories and develop community models to turn the tide on the epidemic. Nashville Public Television entered the fray with its seven-part series, “NPT Reports: Children’s Health Crisis,” identifying key threats to children. The second documentary in the series, hosted by actress and mother of two Kimberly Willliams-Paisley, focused on childhood obesity.

The not-for-profit BCBST Health Foundation sponsored the Childhood Obesity Best Practices Forum at the Adventure Science Center. “The goal of the foundation is to work on the improvement of the health status of Tennesseans through improved lifestyles and promotion of activities that offer defined healthy outcomes,” explained Calvin Anderson, vice president of Federal and Community Relations for BCBST and executive director of the foundation.

He continued, “It’s helpful to share what has been proven as best practices from organizations that have actually worked with real populations and had some measured results.” To that end, representatives from Mountain States Foundation in East Tennessee and GoTrybe in Middle Tennessee offered programming insights and highlighted outcomes. The Bristol, Tenn. YMCA also addressed their successful take on the 5-2-1-0 campaign — 5 fruits and vegetables, no more than 2 hours of screen time, at least 1 hour of active play, and 0 sugary drinks each day. Anderson also noted attendees benefitted from the ability to network with each other and uncover resources both for information and potential funding.

“Thirdly, I think they really did get a sense of the number and statistics nationally, as well as extrapolating it down to the numbers that permeate the state, to better understand the depth of need and scope of the problem we face with childhood obesity,” he said.

While cost avoidance tied to obesity and its comorbid conditions is undeniably attractive to payers, Anderson stressed BCBST looks at the issue in the much broader context of working toward a healthier, happier, more productive population. He also emphasized the foundation’s commitment to attacking the obesity epidemic on multiple fronts. “We don’t get involved with things as a simple ‘one shot,’” he said. “Our premise is to remain engaged in this issue.” (See box for other initiatives.)

Echoing those sentiments, Inga Himelright, MD, MPH, MBA, associate chief medical officer for BCBST, noted, “Our commitment to obesity goes back many years to the WalkingWorks program, which is over 10 years ago. We recognize the effects of obesity are far reaching in the population,” she continued, enumerating recognized complications including diabetes, hypertension, heart disease and stroke. “That makes us a natural proponent to address the issue in the state of Tennessee.”

Himelright added most of what BCBST sponsors in terms of community activities is open to all Tennesseans. “The likelihood that you could change behavior by only going after a limited segment of the population would probably not result in success.” However, she said, taking a multipronged approach and applying it to the broader population has a much better chance of succeeding over time … particularly when good ideas are shared and replicated. While Himelright said it would take months or years to ‘move the needle’ on the obesity epidemic, past experience has taught BCBST that bringing stakeholders together in a collaborative spirit speeds adaptation of best practices into the community.

Where the recent BlueCross effort was centered on professionals working with children, the Nashville Public Television (NPT) program outlined the problem for the general public. Beth Curley, president and CEO of NPT, noted, “Public television really does have a mandate to serve the community.” She continued, “In many, many health measures, our children are in the bottom five in the country. We thought, ‘OK, this is something we need to pay attention to.’” The program is available for viewing online at no charge at http://wnpt.org/childrenshealth and a DVD has been produced in five languages — English, Spanish, Arabic, Nepali and Somali.

Mayor Karl Dean, U.S. Surgeon General Regina Benjamin, MD, and Director of Metro Health Bill Paul, MD, each underscored their commitment to reversing the dual threat of overweight and inactivity during the local launch event held at Lockeland Elementary Design Center.

Paul said that left unchecked, the obesity epidemic would result in a dramatic increase in diabetes — from the current rate of 1 in 10 adults in Tennessee being diagnosed with diabetes to a predicted rate of 1 in 3. He added the epidemic isn’t one solely of personal irresponsibility but is multifactorial in nature. “There is no magic bullet ... no vaccine … but talking about it does help. And as a community, Nashville is already heeding a call to action.”

He encouraged the audience to view the documentary, which explores some of the root causes of the issue along with measures to combat the epidemic, but added tongue-in-cheek, “As a health director, it’s very rare for me to get up in front of someone and tell them to watch TV.”

The documentary highlights sobering statistics including 1 of every 5 children in Tennessee is obese, almost 38 percent report watching more than three hours of television daily, and 6 out of 10 children do not get the recommended levels of physical activity.

While readily acknowledging the problem, Mayor Dean also said, “The good news is that we can change that. You can change behavior. If we take it seriously enough, devote enough energy and time to it and give people enough encouragement to change their behavior, they do.” Dean pointed to the number of people who have stopped using tobacco and adopted seatbelt use as success stories in public health and awareness campaigns.

As a city, he continued, “We need to get obsessed about having healthy children and stay obsessed about having healthy children. We need to have high expectations for our city, for our children, and for ourselves.”

Taking the podium, Surgeon General Regina Benjamin, MD, said it was time to focus on a positive message … to quit talking about what we can’t have and can’t do and instead to look at all the nutritious food that tastes great and fun ways to stay fit. “I believe that exercise is medicine,” she said. “I also think we ought to have fun. Make exercise something you like.”

Although creating specific programs to improve health will remain an important part of any obesity-fighting measures, there is an increasing shift in focus toward public policy efforts. Paul noted, “If you really want to change things in the long run, you really need to get into making the environment more health-friendly.”

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Heading: BlueCross Initiatives to Encourage Healthier Lifestyles

In addition to the recent forum on childhood obesity held in Nashville, BlueCross BlueShield of Tennessee has spearheaded several other programs and initiatives to help both members and non-members live healthier lives. The carrier also links individuals together to participate in activities of interest such as biking or running through meetup.com and now sponsors a Pandora radio station with exercise music. (See related article on page xx, Next Generation Marketing.)

• The BCBST Health Foundation has granted more than $250,000 to the Mountain States Foundation, to bring the “Growing Healthy” program into six school systems in northeast Tennessee. www.mountainstatesfoundation.org/grow.cfm?id=64
• The WalkingWorks for Schools program has proved to be popular and successful in providing fitness opportunities for Tennessee students. www.walkingworksforschoolstn.com
• The foundation funded the health-related exhibit “Good For You” at Creative Discovery Museum in Chattanooga to target childhood obesity and will now fund the travel of the exhibition across the state over the next three years. www.bcbst.com/about/community/video/cdm.shtml
• BlueCross produced Born to Move: A Family Approach to Healthy Living, a 23-minute video designed to help healthcare professionals, teachers and parents understand the childhood obesity crisis.
• The Good Health Club promotes healthy choices and behaviors in children through age-appropriate communications to help spread the 5-2-1-0 message. The related Physician Toolkit assists family doctors in working with patients on the issues of childhood obesity and diabetes. www.bcbs.com/innovations/good-health-club
• Beginning this month, BlueCross will offer free participation in the SilverSneakers program to members of Medicare Advantage and Medicare Supplement plans. www.silversneakers.com

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Heading: Nashville Receives $7.5 Million to Fight Obesity

Last spring, Nashville was the recent recipient of $7.5 million Communities Putting Prevention to Work grant to help curb the city’s obesity epidemic. “The intent of this is really to create healthier places throughout Nashville,” explained Bill Paul, MD, director of Metro Health Department.

A portion of the grant, made possible through stimulus dollars, will be used to address food deserts in the city. Metro Health has identified four food deserts, one in each part of the city except West Nashville, where residents do not have easy access to fresh fruits, vegetables and meats. Instead, residents in these areas rely heavily on processed, packaged food available from convenience stores. The Metro Health Department is launching a campaign this month to increase access to nutritional fare and to raise awareness about healthy meal options in homes, schools, churches and at work. Expanded exercise options are also a focus of the funding. The bike-sharing program launched in 2010 was made possible through this grant.

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