State Category: South Carolina

U.S. Obesity Rates at Historic Highs – Nine States Reach Adult Obesity Rates of 35 Percent or More

 Report Calls for Sugary Drink Taxes, Expanded SNAP and WIC Nutrition Support Programs and a built environment that encourages physical activity to Help Address Health Crisis

(Washington, DC – September 12, 2019) – Nine U.S. states had adult obesity rates above 35 percent in 2018, up from seven states at that level in 2017, an historic level of obesity in the U.S., according to the 16th annual State of Obesity: Better Policies for a Healthier America report released today by the Trust for America’s Health (TFAH).

The report based in part on newly released data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), and analysis by TFAH, provides an annual snapshot of obesity rates nationwide.  The State of Obesity series and this report were made possible by funding from the Robert Wood Johnson Foundation.

Obesity has serious health consequences including increased risk for type 2 diabetes, high blood pressure, stroke and many types of cancers. Obesity is estimated to increase national healthcare spending by $149 billion annually (about half of which is paid for by Medicare and Medicaid) and being overweight or obese is the most common reason young adults are ineligible for military service.

Obesity rates vary considerably between states with Mississippi and West Virginia having the highest level of adult obesity in the nation at 39.5 percent and Colorado having the lowest rate at 23.0 percent.

For the first time, adult obesity rates were above 35 percent in nine states in 2018: Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota and West Virginia.

As recently as 2012, no state had an adult obesity rate over 35 percent and within the last five years (2013 and 2018) 33 states had statistically significant increases in their rates of adult obesity.

“These latest data shout that our national obesity crisis is getting worse,” said John Auerbach, President and CEO of Trust for America’s Health. “They tell us that almost 50 years into the upward curve of obesity rates we haven’t yet found the right mix of programs to stop the epidemic.   Isolated programs and calls for life-style changes aren’t enough.  Instead, our report highlights the fundamental changes that are needed in the social and economic conditions that make it challenging for people to eat healthy foods and get sufficient exercise.”


Differential Impact Amongst Minority Populations

The report highlights that obesity levels are closely tied to social and economic conditions and that individuals with lower incomes are more at risk. People of color, who are more likely to live in neighborhoods with few options for healthy foods and physical activity, and, are the target of widespread marketing of unhealthy foods, are at elevated risk.

As of 2015-2016, the latest available data, nearly half of Latino (47 percent) and Black adults (46.8) had obesity while adult obesity rates among White and Asian adults were 37.9 percent and 12.7 percent respectively.  Incidence of childhood obesity was highest amongst Latino children at 25.8 percent while 22 percent of Black children had obesity, 14 percent of White children had obesity and 11 percent of Asian children had obesity.


What Could Work?

While the obesity rates are alarming, there are new data offering the promise of policies that combat the epidemic, namely promoting healthier food for children through revamped WIC food packages and fostering behavior change through taxes on sugary drinks.

  • Obesity rates for children enrolled in WIC (Special Supplemental Nutrition Program for Women, Infants and Children) continue to decline, from 15.9 percent in 2010 to 13.9 percent in 2016. In 2009, the USDA updated WIC food packages to more closely meet recommended national dietary guidelines including the addition of more fruits, vegetables and whole grains and reduced fat levels in milk and infant formula. A Los Angeles County study published this year found that 4-year-olds who had received the revised WIC food package since birth had reduced risk for obesity.
  • A number of U.S. cities and the Navajo Nation have passed local taxes on sugary drinks that are showing promise as a means to change consumers’ beverage habits. Studies of a 1-cent per ounce tax in Berkeley, California and a 1.5 cent per ounce tax in Philadelphia, Pennsylvania found that the consumption of sugary drinks decreased significantly after the tax was imposed.

“Policies such as these are proving effective in changing behavior. But, no single solution – however promising – is sufficient.  Obesity is a complex problem and will need multi-sector, multi-factor solutions,” said TFAH’s Auerbach.

“Creating the conditions that allow people to more easily make healthy choices is central to preventing obesity, as is prioritizing investment in those communities most affected by the crisis,” Auerbach said.


Recommendations for Policy Action

The report includes 31 recommendations for policy action by federal, state and local government, across several sectors, designed to improve access to nutritious foods and provide safe opportunities for physical activity, while minimizing harmful marketing and advertising tactics.

Among the report’s recommendations for policies to address the obesity crisis are:

  • Expand the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to age 6 for children and for two years postpartum for mothers and fully fund the WIC breastfeeding Peer Counseling Program.
  • Increase the price of sugary drinks through excise taxes and use the revenue to address health and socioeconomic disparities.
  • Ensure that CDC has enough funding to grant every state appropriate funding to implement evidence-based obesity prevention strategies (currently, CDC only has enough funding to work with 16 states).
  • Make it more difficult to market unhealthy food to children by ending federal tax loopholes and business costs deductions related to the advertising of such foods to young audiences.
  • Fully fund the Student Support and Academic Enrichment program and other federal programs that support student physical education.
  • Encourage safe physical activity by funding Safe Routes to Schools (SRTS), Complete Streets, Vision Zero and other pedestrian safety initiatives through federal transportation and infrastructure funding.
  • Ensure that anti-hunger and nutrition-assistance programs, like the Supplemental Nutrition Assistance Program (SNAP), WIC, and others follow the Dietary Guidelines for Americans and make access to nutritious food a core program tenet.
  • Strengthen and expand school nutrition programs beyond federal standards to include universal meals, flexible breakfasts and eliminate all unhealthy food marketing to students.
  • Enforce existing laws that direct most health insurers to cover obesity-related preventive services at no-cost sharing to patients.
  • Cover evidence-based comprehensive pediatric weight management programs and services in Medicaid.

 

State by State rates of adult obesity – highest to lowest

Tie: Mississippi and West Virginia (39.5%), 3. Arkansas (37.1%), 4. Louisiana (36.8%), 5. Kentucky (36.6%), 6. Alabama (36.2%), 7. Iowa (35.3%), 8. North Dakota (35.1%), 9. Missouri, (35.0%),  10. – Tie: Oklahoma and Texas (34.8%), 12. – Tie: Kansas and Tennessee (34.4%), 14. South Carolina (34.3 %), 15. – Tie: Indiana and Nebraska (34.1%), 17. Ohio (34.0%), 18. Delaware (33.5%), 19 – Tie: Michigan, North Carolina (33.0), 21. Georgia (32.5%), 22. New Mexico (32.3%), 23. Wisconsin (32.0%), 24. Illinois (31.8%), 25. – Tie: Maryland and Pennsylvania (30.9%), 27. Florida (30.7%), 28 – Tie: Maine and Virginia (30.4%), 30. Tie: Minnesota and South Dakota (30.1%), 32. Oregon (29.9 %), 33. New Hampshire (29.6%), 34. Three-way Tie: Alaska, Arizona and Nevada (29.5%), 37. Wyoming (29.0%), 38. Washington (28.7%), 39. Idaho (28.4%), 40. Utah (27.8%), 41. Rhode Island (27.7%), 42. New York (27.6%), 43. Vermont (27.5%), 44. Connecticut (27.4%), 45. Montana (26.9%), 46. California (25.8%), 47. – Tie: Massachusetts and New Jersey (25.7%), 49. Hawaii (24.9%), 50. District of Columbia (24.7%), 51. Colorado (23.0%).

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  www.tfah.org. Twitter: @healthyamerica1

 

 

 

 

Tasas de obesidad en Estados Unidos con altos récords históricos

Nueve estados alcanzan tasas de obesidad en adultos superiores al 35 por ciento

El Reporte demanda por Impuestos para las Bebidas Azucaradas, Programas Ampliados de Apoyo Nutricional SNAP y WIC y un entorno que fomente la actividad física para ayudar a abordar la crisis de salud

(Washington, DC) – 12 de septiembre de 2019 – Nueve estados de EE. UU. Tenían tasas de obesidad en adultos superiores al 35 por ciento en 2018, en comparación con siete estados en ese nivel en 2017, un nivel histórico de obesidad en los EE. UU., Según el 16 ° Estado anual de Obesidad: mejores políticas para un informe más saludable de América publicado hoy por el Trust for America’s Health (TFAH).

El informe basado en parte en datos recientemente publicados del Sistema de Vigilancia del Factor de Riesgo del Comportamiento (BRFSS, por su sigla en ingles) de los Centros para el Control y la Prevención de Enfermedades, y el análisis realizado por TFAH, proporciona las tasas de obesidad anuales en todo el país. La serie El estado de la obesidad y este informe fueron posibles gracias a el financiamiento de la Fundación Robert Wood Johnson.

La obesidad tiene graves consecuencias para la salud, incluido un mayor riesgo de diabetes tipo 2, presión arterial alta, accidente cerebrovascular y muchos tipos de cáncer. Se estima que la obesidad aumenta el gasto nacional en atención médica en $ 149 billones anuales (aproximadamente la mitad de lo cual es pagado por Medicare y Medicaid) y el sobrepeso y la obesidad es la razón más común por la que los adultos jóvenes no son elegibles para el servicio militar.

Las tasas de obesidad varían considerablemente entre los estados, con Mississippi y West Virginia con el nivel más alto de obesidad en adultos en la nación con 39.5 por ciento y Colorado con la tasa más baja con 23.0 por ciento.

Por primera vez, las tasas de obesidad en adultos superaron el 35 por ciento en nueve estados en 2018: Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Dakota del Norte y Virginia Occidental.

No muy lejos atrás en el 2012, ningún estado tenía una tasa de obesidad en adultos superior al 35 por ciento y en los últimos cinco años (2013 y 2018) 33 estados tuvieron incrementos estadísticamente significativos en sus tasas de obesidad en adultos.

“Estos últimos datos indican que nuestra crisis nacional de obesidad está empeorando”, dijo John Auerbach, presidente y director ejecutivo de Trust for America’s Health. “Nos dicen que casi 50 años después de la curva ascendente de las tasas de obesidad todavía no hemos encontrado la combinación correcta de programas para detener la epidemia”. Los programas aislados y los llamados a cambios en el estilo de vida no son suficientes. En cambio, nuestro informe destaca los cambios fundamentales que se necesitan en las condiciones sociales y económicas que hacen que sea difícil para las personas comer alimentos saludables y hacer suficiente ejercicio “.

Impacto diferencial entre las poblaciones minoritarias

El informe destaca que los niveles de obesidad están estrechamente vinculados a las condiciones socioeconómicas. Las personas con ingresos más bajos están más en riesgo. Las comunidades de color, que tienen más probabilidades de vivir en vecindarios con pocas opciones de alimentos saludables y actividad física, y que a menudo son el objetivo de una comercialización generalizada de alimentos poco saludables, también tienen un riesgo elevado.

A partir de 2015-2016, casi la mitad de los adultos latinos (47 por ciento) y los adultos negros (46.8) tenían obesidad, mientras que las tasas de obesidad entre adultos blancos y asiáticos fueron de 37.9 por ciento y 12.7 por ciento respectivamente. La incidencia de obesidad también fue más alta entre los niños latinos con un 25.8 por ciento, mientras que el 22 por ciento de los niños negros tienen obesidad, el 14 por ciento de los niños blancos tienen obesidad y el 11 por ciento de los niños asiáticos tienen obesidad.

¿Qué podría funcionar?

Si bien las tasas de obesidad son alarmantes, hay nuevos datos que ofrecen la promesa de políticas que combaten la obesidad, como promover alimentos más saludables para los niños a través de paquetes de alimentos renovados de WIC y fomentar el cambio de comportamiento a través de impuestos sobre las bebidas azucaradas.

  • Las tasas de obesidad para los niños inscritos en WIC (Programa Especial de Nutrición Suplementaria para Mujeres, Bebés y Niños) continúa disminuyendo, de 15.9 por ciento en 2010 a 13.9 por ciento en 2016. En 2009, el Departamento de Agricultura de los Estados Unidos (USDA, por su siglas en inglés) actualizó los paquetes de alimentos de WIC para cumplir más estrechamente con las recomendaciones nacionales. pautas dietéticas que incluyen la adición de más frutas, verduras y granos integrales y niveles reducidos de grasa en la leche y la fórmula infantil. Un estudio del condado de Los Ángeles publicado este año encontró que los niños de 4 años que habían recibido el paquete de alimentos WIC revisado desde su nacimiento habían reducido los riegos de padecer obesidad.
  • Varias ciudades de EE. UU. Y la Nación Navajo han aprobado impuestos locales sobre las bebidas azucaradas que se muestran prometedoras como un medio para cambiar los hábitos de bebidas de los consumidores. Los estudios de un impuesto de 1 centavo por onza en Berkeley, California y un impuesto de 1,5 centavos por onza en Filadelfia, Pensilvania, encontraron que el consumo de bebidas azucaradas disminuyó significativamente después de la imposición del impuesto.

“Políticas como estas están demostrando ser efectivas para cambiar el comportamiento. Pero, ninguna solución única, por prometedora que sea, es suficiente. La obesidad es un problema complejo y necesitará soluciones multisectoriales y multifactoriales “, dijo Auerbach de TFAH.

“Crear las condiciones que permitan a las personas tomar decisiones saludables con mayor facilidad es fundamental para prevenir la obesidad, al igual que priorizar la inversión en las comunidades más afectadas por la crisis”, dijo Auerbach.

Recomendaciones para la acción política

El informe incluye 31 recomendaciones para la acción política del gobierno federal, estatal y local, en varios sectores, diseñado para mejorar el acceso a alimentos nutritivos y proporcionar oportunidades seguras para la actividad física, al tiempo que minimiza las tácticas perjudiciales de marketing y publicidad.

Entre las recomendaciones del informe para las políticas para abordar la crisis de obesidad están:

  • Ampliar el Programa Especial de Nutrición Suplementaria para Mujeres, Bebés y Niños (WIC) a los 6 años para niños y durante dos años después del parto para las madres y financiar completamente el Programa de Orientación de Pares de WIC para la lactancia materna.
  • Aumentar el precio de las bebidas azucaradas mediante impuestos especiales y utilizar los ingresos para abordar las disparidades socioeconómicas y de salud.
  • Asegurarse de que los CDC tengan los recursos suficientes para otorgar a cada estado fondos apropiados para implementar estrategias de prevención de la obesidad basadas en evidencia (actualmente, los CDC solo tienen fondos suficientes para trabajar con 16 estados).
  • Hacer que sea más difícil comercializar alimentos no saludables para los niños al poner fin a los vacíos fiscales federales y las deducciones de costos comerciales relacionados con la publicidad de dichos alimentos para el público joven.
  • Financiar completamente el programa de Apoyo al Estudiante y Enriquecimiento Académico y otros programas federales que apoyan la educación física del estudiante.
  • Fomentar la actividad física segura mediante la financiación de Rutas Seguras a las Escuelas (SRTS), Complete Streets, Vision Zero y otras iniciativas de seguridad para peatones a través de fondos federales de infraestructura y transporte.
  • Asegurar de que los programas contra el hambre y la asistencia nutricional, como el Programa de Nutrición Suplementaria (SNAP), WIC y otros, sigan las Pautas dietéticas para estadounidenses y hagan del acceso a alimentos nutritivos un principio básico del programa.
  • Fortalecer y expandir los programas de nutrición escolar más allá de los estándares federales para incluir comidas universales, desayunos flexibles y eliminar todo el mercadeo de alimentos poco saludables para los estudiantes.
  • Hacer cumplir las leyes existentes que ordenan a la mayoría de las aseguradoras de salud que cubran los servicios preventivos relacionados con la obesidad sin costo compartido para los pacientes.
  • Cubrir el manejo del programa integral del peso pediátrico basado en evidencia y servicios en Medicaid.

Tasas de obesidad adulta por estado, de mayor a menor:

1. (Empatados): Mississippi and Virginia Occidental (39.5%), Arkansas (37.1%), 4. Louisiana (36.8%), 5. Kentucky (36.6%), 6. Alabama (36.2%), 7. Iowa (35.3%), 8. Dakota del Norte (35.1%), 9. Missouri, (35.0%), 10. – Empatados: Oklahoma and Texas (34.8%), 12. – Empatados: Kansas and Tennessee (34.4%), 14.  Carolina del Sur (34.3 %), 15. – : Indiana and Nebraska (34.1%), 17. Ohio (34.0%), 18. Delaware (33.5%), 19 – Empatados: Michigan, Carolina del Norte (33.0), 21. Georgia (32.5%), 22. Nuevo Mexico (32.3%), 23. Wisconsin (32.0%), 24. Illinois (31.8%), 25. – Empatados: Maryland and Pennsylvania (30.9%), 27. Florida (30.7%), 28 – Empatados: Maine and Virginia (30.4%), 30. Empatados: Minnesota and Dakota del Sur (30.1%), 32. Oregon (29.9 %), 33. New Hampshire (29.6%), 34. Empatados: Alaska, Arizona and Nevada (29.5%), 37. Wyoming (29.0%), 38. Washington (28.7%), 39. Idaho (28.4%), 40. Utah (27.8%), 41. Rhode Island (27.7%), 42. Nueva York (27.6%), 43. Vermont (27.5%), 44. Connecticut (27.4%), 45. Montana (26.9%), 46. California (25.8%), 47. – Empatados: Massachusetts and Nueva Jersey (25.7%), 49. Hawaii (24.9%), 50. Districto de Columbia (24.7%), 51. Colorado (23.0%).

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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades una prioridad nacional. WWW.tfah.org

 

Half of States Scored 5 or Lower Out of 10 Indicators in Report on Health Emergency Preparedness

Report Finds Funding to Support Base Level of Preparedness Cut More than Half Since 2002

 

Washington, D.C., December 19, 2017 – In Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 25 states scored a 5 or lower on 10 key indicators of public health preparedness. Alaska scored lowest at 2 out of 10, and Massachusetts and Rhode Island scored the highest at 9 out of 10.

The report, issued today by the Trust for America’s Health (TFAH), found the country does not invest enough to maintain strong, basic core capabilities for health security readiness and, instead, is in a continued state of inefficiently reacting with federal emergency supplemental funding packages each time a disaster strikes.

According to Ready or Not?, federal funding to support the base level of preparedness has been cut by more than half since 2002, which has eroded advancements and reduced the country’s capabilities.

“While we’ve seen great public health preparedness advances, often at the state and community level, progress is continually stilted, halted and uneven,” said John Auerbach, president and CEO of TFAH.  “As a nation, we—year after year—fail to fully support public health and preparedness. If we don’t improve our baseline funding and capabilities, we’ll continue to be caught completely off-guard when hurricanes, wildfires and infectious disease outbreaks hit.”

Ready or Not? features six expert commentaries from public health officials who share perspectives on and experiences from the historic hurricanes, wildfires and other events of 2017, including from California, Florida, Louisiana and Texas.

The report also examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

  • Just 19 states and Washington, D.C. increased or maintained funding for public health from Fiscal Year (FY) 2015-2016 to FY 2016-2017.
  • The primary source for state and local preparedness for health emergencies has been cut by about one-third (from $940 million in FY 2002 to $667 million in FY 2017) and hospital emergency preparedness funds have been cut in half ($514 million in FY 2003 to $254 million in FY 2017).
  • In 20 states and Washington, D.C. 70 percent or more of hospitals reported meeting Antibiotic Stewardship Program core elements in 2016.
  • Just 20 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017—and no state was above 56 percent.
  • 47 state labs and Washington, D.C. provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Communities should maintain a key set of foundational capabilities and focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of core capabilities so they are ready when needed. In addition, a complementary Public Health Emergency Fund is needed to provide immediate surge funding for specific action for major emerging threats.
  • Strengthening and maintaining consistent support for global health security as an effective strategy for preventing and controlling health crises. Germs know no borders.
  • Innovating and modernizing infrastructure needs – including a more focused investment strategy to support science and technology upgrades that leverage recent breakthroughs and hold the promise of transforming the nation’s ability to promptly detect and contain disease outbreaks and respond to other health emergencies.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks.  Develop stronger coalitions and partnerships among providers, hospitals and healthcare facilities, insurance providers, pharmaceutical and health equipment businesses, emergency management and public health agencies.
  • Preventing the negative health consequences of climate change and weather-related threats. It is essential to build the capacity to anticipate, plan for and respond to climate-related events.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop superbugs and antibiotic resistance. 
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.
  • Supporting a culture of resilience so all communities are better prepared to cope with and recover from emergencies, particularly focusing on those who are most vulnerable.   Sometimes the aftermath of an emergency situation may be more harmful than the initial event.  This must also include support for local organizations and small businesses to prepare for and to respond to emergencies.

The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

9 out of 10: Massachusetts and Rhode Island

8 out of 10: Delaware, North Carolina and Virginia

7 out of 10: Arizona, Colorado, Connecticut, Hawaii, Minnesota, New York, Oregon and Washington

6 out of 10: California, District of Columbia, Florida, Illinois, Maryland, Nebraska, New Jersey, North Dakota, South Carolina, South Dakota, Utah, Vermont and West Virginia

5 out of 10: Georgia, Idaho, Maine, Mississippi, Montana and Tennessee

4 out of 10: Alabama, Arkansas, Iowa, Louisiana, Missouri, New Hampshire, Oklahoma and Pennsylvania

3 out of 10: Indiana, Kansas, Kentucky, Michigan, Nevada, New Mexico, Ohio, Texas, Wisconsin and Wyoming

2 out of 10: Alaska

 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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Connecting Diabetes Care from the Clinic to the Community

BY JOHNNA REED, vice president, business development, Bon Secours Health System

In 2011, the Bon Secours St. Francis Health System in Greenville, South Carolina created a Diabetes Integrated Practice Unit (IPU) to foster a new environment that improves the health of patients with, or at risk of developing, type 2 diabetes.

Since most of the factors that influence health exist outside of the doctor’s office, we’ve learned the importance of connecting our patients to resources in their communities. This helps them in their daily lives and better supports their ongoing medical care.

The goal of the Diabetes IPU is to connect patients with community resources that can help benefit their health through improved nutrition, increased physical activity and support to manage their condition. The program also ensures that physicians and other caregivers have sufficient time to focus on their patient’s needed care. This added time also allows providers and patients to work together to understand how obesity, prediabetes and diabetes can affect health and daily life and to set goals that work for each patient’s unique circumstances. 

The program also emphasizes the importance of prevention, to avoid developing additional health risks or problems in the future. We help prediabetics avoid the progression to diabetes and help diabetics avoid developing additional conditions.

The program is designed around a network of community and clinical resources, providers and technology. While the program hub is at St. Francis Millennium, the programs themselves are delivered where patients are—at work, home, and throughout the community.

The Diabetes IPU includes an extensive coordinated team of care givers, including a primary care physician, ophthalmology, cardiology, nephrology and podiatry services, and an endocrinologist who consults with the primary care physicians regarding innovations in diabetes care and assists with the care of patients facing particular medical challenges.

The medical care is managed by a registered nurse care coordinator. It’s also important to note that our care team includes a psychologist, social worker, registered dietician, diabetes educator, pharmacist, and an exercise physiologist to help patients get to a healthy weight. It is not just a clinicalcentered approach — it’s a total community health approach.

HOW THE IPU WORKS:

A patient’s initial visit with the diabetes team begins with a fasting blood draw to determine blood glucose, HbA1c, cholesterol, and other relevant lab values. Following the blood draw, patients are provided a diabetes-appropriate breakfast. Next, the patient is asked to participate in a small group discussion about issues they have in dealing with diabetes, led by a diabetes educator and nurse. Facilitators are continually surprised at the level of engagement in these groups — patients tend to share readily and openly.

The group discussion not only introduces patients to others who share similar health and lifestyle challenges—including being overweight or obese and struggling to engage in physical activity and eat healthy—but also enables the nurse facilitator to determine the best match for the patient with individual caregivers. After the discussion, the entire group receives an introduction to exercise with an exercise physiologist who provides an easy, low stress overview of exercise options.

In the course of this first morning, the patient sees the primary physician, psychologist, diabetes educator, and registered dietitian. Each patient also receives a retinal scan and foot exam. Finally, patients are served a diabetes friendly lunch with the clinical team present to answer questions about the food or anything else related to diabetes.

However, our work doesn’t stop when the patient leaves the clinic. Because the needs of patients with type 2 diabetes require support and resources in the community, our diabetes program provides worksite and home services. After their visit, a team member meets with patients in their home to assess the support network available and to identify areas where patients will face particular challenges. Our teams then work with family and employers to inform and facilitate improvements in the home and work environments and sometimes in the local grocery stores and pharmacies.

Often, the care team conducts a thorough workplace assessment to determine how each patient’s work setting impacts his or her health. For example, if there is no access to healthy foods, we work with the employer to improve the food options at a worksite. It might be surprising that employers have been incredibly supportive, however they fully understand the importance of having a healthy, happy, and productive workforce.

From the patient perspective, the most important measure is improvement in the ability to live (i.e., to work, participate in family life, attend important events, and enjoy daily activities). With each patient, the care team identifies capabilities that are motivating and meaningful and track their improvement. While these measures require greater effort to quantify, they are often the drivers of people’s long-term commitment to lifestyle change and health.

Patients have responded incredibly well. A recent patient entered the program hoping to improve his health, get off regular insulin and lose about 60 lbs. With the diabetes team’s help, he understood the need to deny barriers and stressors, such as fast food and sugary drinks, and was very successful.

Through the program, he increased glucose monitoring from to three to four times daily; went from not exercising at all to exercising four times a week at the facility we recommended to him; attended all prescribed education opportunities and shared medical group appointments; and engaged often with our dietician. While he hasn’t yet reached all his top-level goals, he lost more than 45 lbs., reduced his BMI from 33.7 to 27.5 and his waist size from 44 to 36, and no longer needs mealtime insulin coverage.

The most successful patients are the ones who receive a continuum of care from the clinic to their community. Our model improves a physician’s capability by bringing all of the necessary community resources together. Research shows that what happens outside the doctor’s office can have a major impact—either positive or negative—on our health. That’s why we began the Diabetes IPU model and why we’ll continue using it to fight obesity and improve the care of individuals with prediabetes or diabetes.