Childhood Obesity: The Role of Health Policy - Association of ...

“I absolutely believe that the health care
system has an important role in solving this
epidemic, but that medical efforts must be
coupled with changes in the environment
outside the clinic walls.”
William H. Dietz, MD, MPH
Centers for Disease Control and Prevention
A review of the activities of leading policy
organizations focused at the state or national
level and/or active in childhood obesity reveals
that most of the related policy attention in
childhood obesity is focused on sectors other
than health care. Notably, school policies are a
common target of state legislative or executive
branch activities (Winterfeld, 2006). In addition,
strategies directed at the built environment
(e.g., the accessibility of recreational
facilities, bike and walking trails, and safe neighborhoods) have grown as a focus of public policy
(Koplan & Dietz, 1999; Koplan, Liverman & Kraak, 2005; Cotten, 2006; Powell et al., 2007a & 2007b).
Yet, healthcare policy can support or hinder the ability of the healthcare system to address the obesity
challenge and be an active partner in multifaceted interventions (Homer & Simpson, 2007). While an
obvious example is in the area of reimbursement for health care services, many other aspects of healthcare
policy should be addressed, including, at least: 1) research and demonstration funding and priorities
needed to identify effective prevention and treatment approaches; 2) training and competency of
healthcare professionals in preventing, identifying and treating affected children and families; 3) inclusion
of obesity-related services in benefit coverage; 4) incentives for providers and health plans to
address the issue; 5) support of innovations, including quality improvement; and 6) the role of health
information technology (e.g. decision-support systems and obesity registries). This report serves to lay
a foundation for the response by the healthcare system to the challenge of childhood obesity and guide
the activities of the Childhood Obesity Action Network (COAN).
III. Methods
This report is the result of a two-year effort conducted in three phases: pre-Summit and Congress (discovery
and design), Summit and Congress, and post-Summit and Congress (dissemination and development
of an ongoing learning network within the National Initiative for Children’s Healthcare Quality
(NICHQ)). Our discovery and design phase was conducted from January, 2006 – September, 2006 and
consisted of five components: 1) an expert advisory committee that provided guidance and input
throughout our work; 2) a review of relevant recent reports and literature identified by us and/or members
of one of the four committees impaneled for this initiative; 3) a review of the policy or position
statements of 30 leading healthcare organizations (see Appendix B) to identify similar themes and recommendations;
4) key informant interviews with representatives of leading organizations engaged in
childhood obesity using a semi-structured format adapted from a Robert Wood Johnson Foundation
(RWJF)-funded initiative (McPhillips-Tangum et al., 2007); and 5) information gathering from various
natural groupings of stakeholders, including Medicaid Medical Directors and state chapters of the
American Academy of Pediatrics (AAP). Our work was guided by an oversight Steering committee, consisting
of nationally-recognized experts on pediatric overweight, with strategic subcommittees in place
(see Appendix C). These included a Policy Subcommittee and a Clinical Subcommittee for identification
and assessment of existing innovations.
In the second phase, the Policy Subcommittee provided the 2006 NICHQ Summit and Congress attendees
with a proposed set of policy goals and strategies, as well as promising approaches to improve
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