Obesity What all

health professionals

need to know

Duke Community and Family Medicine Grand Rounds

August 8 2017

Don Bradley- Executive Director The Practical Playbook

Associate Consulting Professor Duke School of Medicine

Objectives

1 Briefly describe updated adult and pediatric obesity trends in the United States

2 Discuss the interprofessional competencies developed by the National Academy of Medicine Roundtable on Obesity Solutions ICSSPMO workgroup for Provider Training and Education

3 Cite specific applications of the competencies for health professionals including

a) Framework of obesity as a disease

b) Integration of clinical and community care for the treatment of obesity

c) Competencies for interactions with persons with obesity

Disclosuresacknowledgements

bull Practical Playbook funded by the deBeaumont Foundation

bull Interprofessional Provider Training and Education partially funded by

the Robert Wood Johnson Foundation

wwwpracticalplaybookorg

Objectives

1 Briefly describe updated adult and pediatric obesity trends in the United States

2 Discuss the interprofessional competencies developed by the National Academy of Medicine Roundtable on Obesity Solutions ICSSPMO workgroup for Provider Training and Education

3 Cite specific applications of the competencies for health professionals including

a) Framework of obesity as a disease

b) Integration of clinical and community care for the treatment of obesity

c) Competencies for interactions with persons with obesity

Disclosuresacknowledgements

bull Practical Playbook funded by the deBeaumont Foundation

bull Interprofessional Provider Training and Education partially funded by

the Robert Wood Johnson Foundation

wwwpracticalplaybookorg

Disclosuresacknowledgements

bull Practical Playbook funded by the deBeaumont Foundation

bull Interprofessional Provider Training and Education partially funded by

the Robert Wood Johnson Foundation

wwwpracticalplaybookorg

Changes in the Prevalence of Obesity among Youth 2-19 yo and Adults gt 20 yo

NHANES 1999-2000 ndash 2013-2014

0

5

10

15

20

25

30

35

40

45

2000 2002 2004 2006 2008 2010 2012 2014

Boys

Girls

Men

Women

Year

40

35

17

Used with permission from Bill Dietz

Ogden 2016

Flegal 2016

Changes in the Prevalence of Severe Obesity in 2-19 yo Youth

NHANES 1999-2000 ndash 2013-2014

0

1

2

3

4

5

6

7

8

9

10

2000 2002 2004 2006 2008 2010 2012 2014

Boys

Girls

Year

9

8

Severe obesity BMI gt120 of

95th Percentile Used with permission from Bill Dietz

Changes in the Prevalence of Severe Obesity (BMI gt 40) in Adults

NHANES 1999-2000 ndash 2013-2014

0

2

4

6

8

10

12

Men

Women

10

6

Year

Used with permission from Bill Dietz

Flegal 2016

Prevalence of Obesity in Selected Age Groups ndash

NHANES 2011-2014

9

17

36

0

5

10

15

20

25

30

35

40

2-5 yo 6-11 yo 20-39 yo

Ogden CL et al NCHS Data

Brief 219 November 2015Used with permission from Bill Dietz

Demographics of People Who Gained gt 20 kg

between 1985-86 and 1995-1996 (CARDIA)

6 7

15

27

0

5

10

15

20

25

30

Men Women

White

Black

Lewis CE et al Am J Epidemiol

20001511172

Used with permission from Bill Dietz

Ethnic Distribution of Obesity in 2-19 yo

NHANES 2011-2014

1415

18

2122

21

0

5

10

15

20

25

Boys Girls

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al

NCHS Data Brief

219 November 2015

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Changes in the Prevalence of Severe Obesity in 2-19 yo Youth

NHANES 1999-2000 ndash 2013-2014

0

1

2

3

4

5

6

7

8

9

10

2000 2002 2004 2006 2008 2010 2012 2014

Boys

Girls

Year

9

8

Severe obesity BMI gt120 of

95th Percentile Used with permission from Bill Dietz

Changes in the Prevalence of Severe Obesity (BMI gt 40) in Adults

NHANES 1999-2000 ndash 2013-2014

0

2

4

6

8

10

12

Men

Women

10

6

Year

Used with permission from Bill Dietz

Flegal 2016

Prevalence of Obesity in Selected Age Groups ndash

NHANES 2011-2014

9

17

36

0

5

10

15

20

25

30

35

40

2-5 yo 6-11 yo 20-39 yo

Ogden CL et al NCHS Data

Brief 219 November 2015Used with permission from Bill Dietz

Demographics of People Who Gained gt 20 kg

between 1985-86 and 1995-1996 (CARDIA)

6 7

15

27

0

5

10

15

20

25

30

Men Women

White

Black

Lewis CE et al Am J Epidemiol

20001511172

Used with permission from Bill Dietz

Ethnic Distribution of Obesity in 2-19 yo

NHANES 2011-2014

1415

18

2122

21

0

5

10

15

20

25

Boys Girls

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al

NCHS Data Brief

219 November 2015

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Changes in the Prevalence of Severe Obesity (BMI gt 40) in Adults

NHANES 1999-2000 ndash 2013-2014

0

2

4

6

8

10

12

Men

Women

10

6

Year

Used with permission from Bill Dietz

Flegal 2016

Prevalence of Obesity in Selected Age Groups ndash

NHANES 2011-2014

9

17

36

0

5

10

15

20

25

30

35

40

2-5 yo 6-11 yo 20-39 yo

Ogden CL et al NCHS Data

Brief 219 November 2015Used with permission from Bill Dietz

Demographics of People Who Gained gt 20 kg

between 1985-86 and 1995-1996 (CARDIA)

6 7

15

27

0

5

10

15

20

25

30

Men Women

White

Black

Lewis CE et al Am J Epidemiol

20001511172

Used with permission from Bill Dietz

Ethnic Distribution of Obesity in 2-19 yo

NHANES 2011-2014

1415

18

2122

21

0

5

10

15

20

25

Boys Girls

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al

NCHS Data Brief

219 November 2015

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Prevalence of Obesity in Selected Age Groups ndash

NHANES 2011-2014

9

17

36

0

5

10

15

20

25

30

35

40

2-5 yo 6-11 yo 20-39 yo

Ogden CL et al NCHS Data

Brief 219 November 2015Used with permission from Bill Dietz

Demographics of People Who Gained gt 20 kg

between 1985-86 and 1995-1996 (CARDIA)

6 7

15

27

0

5

10

15

20

25

30

Men Women

White

Black

Lewis CE et al Am J Epidemiol

20001511172

Used with permission from Bill Dietz

Ethnic Distribution of Obesity in 2-19 yo

NHANES 2011-2014

1415

18

2122

21

0

5

10

15

20

25

Boys Girls

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al

NCHS Data Brief

219 November 2015

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Demographics of People Who Gained gt 20 kg

between 1985-86 and 1995-1996 (CARDIA)

6 7

15

27

0

5

10

15

20

25

30

Men Women

White

Black

Lewis CE et al Am J Epidemiol

20001511172

Used with permission from Bill Dietz

Ethnic Distribution of Obesity in 2-19 yo

NHANES 2011-2014

1415

18

2122

21

0

5

10

15

20

25

Boys Girls

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al

NCHS Data Brief

219 November 2015

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Ethnic Distribution of Obesity in 2-19 yo

NHANES 2011-2014

1415

18

2122

21

0

5

10

15

20

25

Boys Girls

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al

NCHS Data Brief

219 November 2015

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Ethnic Distribution of Obesity in Adults

NHANES 2011-2014

34 3537

57

39

46

0

10

20

30

40

50

60

Men Women

NHW

NHB

Hispanic

Used with permission from Bill Dietz

Ogden CL et al NCHS

Data Brief 219

November 2015

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Prevalence of obesity in adults by poverty income

ration sex race and ethnicity US 2005-2008

Ogden 2010

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Adults with obesity by PIR race and ethnicity US 2005-2008

Ogden 2010

= not ldquopoorrdquo

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Epidemiology of obesity

1 While the prevalence of obesity in

children and adolescents has stabilized

the rate of severe obesity continues to

increase

2 The prevalence of obesity in adults

continues to increase and the increase in

severe obesity is even greater

3 The prevalence of obesity rises

dramatically in early adulthood

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Epidemiology of obesity (2)4 African American and Hispanic

populations are disproportionately impacted by obesity

5 Among men obesity prevalence is generally similar at all income levels with a tendency to be slightly higher at higher income levels

6 Among women obesity prevalence increases as income decreases

7 Most people with obesity are NOT poor

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Competencies for preventing and

managing obesity

bull Competency

ndash An observable ability of a health professional

integrating multiple components such as

knowledge skills values and attitudes

ndash Since competencies are observable they can

be measured and assessed to ensure their

acquisition

Frank JR et al Medical Teacher 2010 32(8)638-645

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Provider Competencies for the

Prevention and Management of Obesity

bull httpscdnbipartisanpolicyorgwp-

contentuploads201707Provider-

Competencies-for-the-Prevention-and-

Management-of-Obesitypdf

Barr interprofessional competencies

1 Common

2 Complementary

3Collaborative

Englander health professions competencies

1 Patient care

2 Knowledge for practice

3 Practice-based learning and improvement

4 Interpersonal and communications skills

5 Professionalism

6 Systems-based practice

7 Interprofessional collaboration

8 Personal and professional development

Interprofessional obesity competencies

1 Demonstrate a working knowledge of obesity as a disease

2 Demonstrate a working knowledge of the epidemiology of the obesity epidemic

3 Describe the disparate burden of obesity and approaches to mitigate it

4 Describe the benefits of working interprofessionally

5 Apply skills for interprofessional collaboration and clinical-community integration hellip

6 Use patient-centered communication hellip

7 Employ strategies to minimize bias towards and discrimination against people with obesity hellip

8 Implement a range of accommodations and safety measures specific to people with obesity

9 Utilize evidence-based careservices for people with obesity or at risk for obesity

10 Provide evidence-based careservices for people with obesity comorbidities

Barr 1998

Englander etal 2013

Bradley Dietz etal 2017

Development framework for interprofessional

obesity competencies

Organizations Engaged in the Development of

Obesity Competencies (listed alphabetically)bull Academy for Eating Disorders

bull Academy of Nutrition and Dietetics

bull Accreditation Council for Graduate Medical Education

bull American Academy of Family Physicians

bull American Academy of Pediatrics

bull American Association of Colleges of Nursing

bull American Association of Colleges of Osteopathic Medicine

bull American Association of Colleges of Pharmacy

bull American Board of Obesity Medicine

bull American Council of Academic Physical Therapy

bull American Dental Education Association

bull American Kinesiology Association

bull American Psychological Association

bull Association for Prevention Teaching

and Research

bull Association of American Medical

Colleges

bull Association of Schools and Programs

of Public Health

bull Centers for Medicare and Medicaid

Services

bull Interprofessional Education

Collaborative

bull National Organization of Nurse

Practitioner Faculties

bull Physician Assistant Education

Association

bull Society for Public Health Education

bull Society of Teachers of Family

Medicine

bull The Obesity Society

bull YMCA of the USA

The Competency Development Process

bull Step 1 Define terms scope application

bull Step 2 Identify and engage diverse stakeholders

bull Step 3 Collect health professionsrsquo competencies

bull Step 4 Draft common competencies iterative stakeholder review

bull Step 5 Disseminate and pilotincorporate competencies

bull Step 6 Identify curricular resources

bull Step 7 Periodic review and updates

Obesity Care Competencies

bull Core Obesity Knowledgendash 10 Demonstrate a working knowledge of obesity as

a disease

ndash 20 Demonstrate a working knowledge of the epidemiology of the obesity epidemic

ndash 30 Describe the disparate burden of obesity and approaches to mitigate it

bull Interprofessional Obesity Carendash 40 Describe the benefits of working

interprofessionally to address obesity to achieve results that cannot be achieved by a single health professional

ndash 50 Apply skills necessary for interprofessionalcollaboration and integration of clinical and community care for obesity

Obesity Care Competencies (2)

bull Patient interactions related to obesity carendash 60 Use patient-centered communication when

working with individuals with obesity and others

ndash 70 Employ strategies to minimize bias towards and discrimination against people with obesity including weight body habitus and the causes of obesity

ndash 80 Implement a range of accommodations and safety measures specific to people with obesity

ndash 90 Utilize evidence-based careservices for people with obesity or at risk for obesity

ndash 100 Provide evidence-based careservices for people with obesity comorbidities

Competency 50 Apply the skills necessary for

effective interprofessional collaboration and

integration of clinical and community care of obesity

bull 51 Perform effectively in an

interprofessional team

bull 52 Promote the development and use of

an integrated clinical-community care plan

bull 53 Collaborate with community

organizations to advocate for nutrition and

physical activity services programs

andor policies that address obesity

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

Organizations Engaged in the Development of

Obesity Competencies (listed alphabetically)bull Academy for Eating Disorders

bull Academy of Nutrition and Dietetics

bull Accreditation Council for Graduate Medical Education

bull American Academy of Family Physicians

bull American Academy of Pediatrics

bull American Association of Colleges of Nursing

bull American Association of Colleges of Osteopathic Medicine

bull American Association of Colleges of Pharmacy

bull American Board of Obesity Medicine

bull American Council of Academic Physical Therapy

bull American Dental Education Association

bull American Kinesiology Association

bull American Psychological Association

bull Association for Prevention Teaching

and Research

bull Association of American Medical

Colleges

bull Association of Schools and Programs

of Public Health

bull Centers for Medicare and Medicaid

Services

bull Interprofessional Education

Collaborative

bull National Organization of Nurse

Practitioner Faculties

bull Physician Assistant Education

Association

bull Society for Public Health Education

bull Society of Teachers of Family

Medicine

bull The Obesity Society

bull YMCA of the USA

The Competency Development Process

bull Step 1 Define terms scope application

bull Step 2 Identify and engage diverse stakeholders

bull Step 3 Collect health professionsrsquo competencies

bull Step 4 Draft common competencies iterative stakeholder review

bull Step 5 Disseminate and pilotincorporate competencies

bull Step 6 Identify curricular resources

bull Step 7 Periodic review and updates

Obesity Care Competencies

bull Core Obesity Knowledgendash 10 Demonstrate a working knowledge of obesity as

a disease

ndash 20 Demonstrate a working knowledge of the epidemiology of the obesity epidemic

ndash 30 Describe the disparate burden of obesity and approaches to mitigate it

bull Interprofessional Obesity Carendash 40 Describe the benefits of working

interprofessionally to address obesity to achieve results that cannot be achieved by a single health professional

ndash 50 Apply skills necessary for interprofessionalcollaboration and integration of clinical and community care for obesity

Obesity Care Competencies (2)

bull Patient interactions related to obesity carendash 60 Use patient-centered communication when

working with individuals with obesity and others

ndash 70 Employ strategies to minimize bias towards and discrimination against people with obesity including weight body habitus and the causes of obesity

ndash 80 Implement a range of accommodations and safety measures specific to people with obesity

ndash 90 Utilize evidence-based careservices for people with obesity or at risk for obesity

ndash 100 Provide evidence-based careservices for people with obesity comorbidities

Competency 50 Apply the skills necessary for

effective interprofessional collaboration and

integration of clinical and community care of obesity

bull 51 Perform effectively in an

interprofessional team

bull 52 Promote the development and use of

an integrated clinical-community care plan

bull 53 Collaborate with community

organizations to advocate for nutrition and

physical activity services programs

andor policies that address obesity

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

The Competency Development Process

bull Step 1 Define terms scope application

bull Step 2 Identify and engage diverse stakeholders

bull Step 3 Collect health professionsrsquo competencies

bull Step 4 Draft common competencies iterative stakeholder review

bull Step 5 Disseminate and pilotincorporate competencies

bull Step 6 Identify curricular resources

bull Step 7 Periodic review and updates

Obesity Care Competencies

bull Core Obesity Knowledgendash 10 Demonstrate a working knowledge of obesity as

a disease

ndash 20 Demonstrate a working knowledge of the epidemiology of the obesity epidemic

ndash 30 Describe the disparate burden of obesity and approaches to mitigate it

bull Interprofessional Obesity Carendash 40 Describe the benefits of working

interprofessionally to address obesity to achieve results that cannot be achieved by a single health professional

ndash 50 Apply skills necessary for interprofessionalcollaboration and integration of clinical and community care for obesity

Obesity Care Competencies (2)

bull Patient interactions related to obesity carendash 60 Use patient-centered communication when

working with individuals with obesity and others

ndash 70 Employ strategies to minimize bias towards and discrimination against people with obesity including weight body habitus and the causes of obesity

ndash 80 Implement a range of accommodations and safety measures specific to people with obesity

ndash 90 Utilize evidence-based careservices for people with obesity or at risk for obesity

ndash 100 Provide evidence-based careservices for people with obesity comorbidities

Competency 50 Apply the skills necessary for

effective interprofessional collaboration and

integration of clinical and community care of obesity

bull 51 Perform effectively in an

interprofessional team

bull 52 Promote the development and use of

an integrated clinical-community care plan

bull 53 Collaborate with community

organizations to advocate for nutrition and

physical activity services programs

andor policies that address obesity

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

Obesity Care Competencies

bull Core Obesity Knowledgendash 10 Demonstrate a working knowledge of obesity as

a disease

ndash 20 Demonstrate a working knowledge of the epidemiology of the obesity epidemic

ndash 30 Describe the disparate burden of obesity and approaches to mitigate it

bull Interprofessional Obesity Carendash 40 Describe the benefits of working

interprofessionally to address obesity to achieve results that cannot be achieved by a single health professional

ndash 50 Apply skills necessary for interprofessionalcollaboration and integration of clinical and community care for obesity

Obesity Care Competencies (2)

bull Patient interactions related to obesity carendash 60 Use patient-centered communication when

working with individuals with obesity and others

ndash 70 Employ strategies to minimize bias towards and discrimination against people with obesity including weight body habitus and the causes of obesity

ndash 80 Implement a range of accommodations and safety measures specific to people with obesity

ndash 90 Utilize evidence-based careservices for people with obesity or at risk for obesity

ndash 100 Provide evidence-based careservices for people with obesity comorbidities

Competency 50 Apply the skills necessary for

effective interprofessional collaboration and

integration of clinical and community care of obesity

bull 51 Perform effectively in an

interprofessional team

bull 52 Promote the development and use of

an integrated clinical-community care plan

bull 53 Collaborate with community

organizations to advocate for nutrition and

physical activity services programs

andor policies that address obesity

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

Obesity Care Competencies (2)

bull Patient interactions related to obesity carendash 60 Use patient-centered communication when

working with individuals with obesity and others

ndash 70 Employ strategies to minimize bias towards and discrimination against people with obesity including weight body habitus and the causes of obesity

ndash 80 Implement a range of accommodations and safety measures specific to people with obesity

ndash 90 Utilize evidence-based careservices for people with obesity or at risk for obesity

ndash 100 Provide evidence-based careservices for people with obesity comorbidities

Competency 50 Apply the skills necessary for

effective interprofessional collaboration and

integration of clinical and community care of obesity

bull 51 Perform effectively in an

interprofessional team

bull 52 Promote the development and use of

an integrated clinical-community care plan

bull 53 Collaborate with community

organizations to advocate for nutrition and

physical activity services programs

andor policies that address obesity

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

Competency 50 Apply the skills necessary for

effective interprofessional collaboration and

integration of clinical and community care of obesity

bull 51 Perform effectively in an

interprofessional team

bull 52 Promote the development and use of

an integrated clinical-community care plan

bull 53 Collaborate with community

organizations to advocate for nutrition and

physical activity services programs

andor policies that address obesity

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

National Academy of Medicine (IOM)

Roundtable on Obesity Solutions 2017

httpsnamedua-model-framework-that-integrates-

community-and-clinical-systems-for-the-prevention-and-

management-of-obesity-and-other-chronic-diseases

Food-insecure

households are

uncertain of having or

unable to acquire at

some time during the

year enough food to

meet the needs of all

their members because

they had insufficient

money or other

resources for food

North Pasadena TexasMission is to eliminate the conditions that cause food insecurity in north Pasadena

1 Produce a sustainable publicly accessible source of healthy food in the form of north Pasadenarsquos first Community-Supported Agriculture (CSA) program and research campus

2 Expand a local network of innovative healthy food suppliers and distributors in north Pasadena (eg corner stores non-franchise restaurants and school-based food co-ops) and

3 Launch the community-clinical linkage initiatives of a Fruit and Vegetable Prescription Policy (FVRx) Food FARMacies and a Food Scholarship Program that help residents access food and make healthy choices

Key Partnersbull Houston Food Bank

bull Harris County Public Health and

Environmental Services

bull The University of Texas MD Anderson

Cancer Center

httpbuildhealthchallengeorgcommunitiesawardee-harris-

county-texas

North Pasadena TexasMission is to eliminate the conditions that cause food insecurity in north Pasadena

1 Produce a sustainable publicly accessible source of healthy food in the form of north Pasadenarsquos first Community-Supported Agriculture (CSA) program and research campus

2 Expand a local network of innovative healthy food suppliers and distributors in north Pasadena (eg corner stores non-franchise restaurants and school-based food co-ops) and

3 Launch the community-clinical linkage initiatives of a Fruit and Vegetable Prescription Policy (FVRx) Food FARMacies and a Food Scholarship Program that help residents access food and make healthy choices

Key Partnersbull Houston Food Bank

bull Harris County Public Health and

Environmental Services

bull The University of Texas MD Anderson

Cancer Center

httpbuildhealthchallengeorgcommunitiesawardee-harris-

county-texas

bull 61 Discuss obesity in a non-judgmental manner

using people first language in all communications

bull 62 Incorporate the environmental social emotional

and cultural context of obesity into conversations

with people with obesity

bull 63 Use person- and family-centered

communication (eg using active listening empathy

autonomy supportshared decision making) to

engage the patient and others

Competency 60 Use patient-centered communication

when working with individuals with obesity and others

People First Language

bull Overweight is a descriptionbull An ldquoobese personrdquo is an identity ndash he or

she is obese not a father mother or a person characterized by their achievements

bull An ldquoobese personrdquo is more likely to be held responsible tor their weight

bull Obesity is a diseasebull Describing a person with obesity focuses

attention on cause

Used with permission from Bill Dietz

Mean ratings of the 11 terms to describe excess weight

Volger 2012

Heavy [Puhl]

Chubby [Puhl]

Morbidly obese [Puhl]

Puhl 2013

Competency 90 Utilize evidence-based careservices for

people with obesity or at risk for obesity

bull 91 Identify credible information to support obesity care

bull 92 Evaluate BMI and other anthropometric measures routinely

bull 93 Identify physical and psychosocial comorbidities and their potential impact on the health of the individual

bull 94 Engage relevant health professionals to initiate a comprehensive care plan using shared decision-making within the personrsquos context

bull 95 Identify access-to-care barriers for patients with obesity and solutions to mitigate those barriers

bull 96 Employ evidence-based individual and family behavioral-change strategies such as motivational interviewing and cognitive behavioral therapy

Measurement of Obesity

bull Body mass index (wt in kgheight in m2)ndash Overweight BMI = 25-299

ndash Obesity BMI gt 30

ndash Severe obesity BMI gt40

bull Fat distribution - waist circumference

bull Children and adolescents ndash percentilesndash Overweight BMI = 85th-95th tile

ndash Obesity gt 95th tile

bull Severe obesity 120 of 95th percentile

BMI as a vital sign

Source Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

People First Language

bull Overweight is a descriptionbull An ldquoobese personrdquo is an identity ndash he or

she is obese not a father mother or a person characterized by their achievements

bull An ldquoobese personrdquo is more likely to be held responsible tor their weight

bull Obesity is a diseasebull Describing a person with obesity focuses

attention on cause

Used with permission from Bill Dietz

Mean ratings of the 11 terms to describe excess weight

Volger 2012

Heavy [Puhl]

Chubby [Puhl]

Morbidly obese [Puhl]

Puhl 2013

Competency 90 Utilize evidence-based careservices for

people with obesity or at risk for obesity

bull 91 Identify credible information to support obesity care

bull 92 Evaluate BMI and other anthropometric measures routinely

bull 93 Identify physical and psychosocial comorbidities and their potential impact on the health of the individual

bull 94 Engage relevant health professionals to initiate a comprehensive care plan using shared decision-making within the personrsquos context

bull 95 Identify access-to-care barriers for patients with obesity and solutions to mitigate those barriers

bull 96 Employ evidence-based individual and family behavioral-change strategies such as motivational interviewing and cognitive behavioral therapy

Measurement of Obesity

bull Body mass index (wt in kgheight in m2)ndash Overweight BMI = 25-299

ndash Obesity BMI gt 30

ndash Severe obesity BMI gt40

bull Fat distribution - waist circumference

bull Children and adolescents ndash percentilesndash Overweight BMI = 85th-95th tile

ndash Obesity gt 95th tile

bull Severe obesity 120 of 95th percentile

BMI as a vital sign

Source Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Mean ratings of the 11 terms to describe excess weight

Volger 2012

Heavy [Puhl]

Chubby [Puhl]

Morbidly obese [Puhl]

Puhl 2013

Competency 90 Utilize evidence-based careservices for

people with obesity or at risk for obesity

bull 91 Identify credible information to support obesity care

bull 92 Evaluate BMI and other anthropometric measures routinely

bull 93 Identify physical and psychosocial comorbidities and their potential impact on the health of the individual

bull 94 Engage relevant health professionals to initiate a comprehensive care plan using shared decision-making within the personrsquos context

bull 95 Identify access-to-care barriers for patients with obesity and solutions to mitigate those barriers

bull 96 Employ evidence-based individual and family behavioral-change strategies such as motivational interviewing and cognitive behavioral therapy

Measurement of Obesity

bull Body mass index (wt in kgheight in m2)ndash Overweight BMI = 25-299

ndash Obesity BMI gt 30

ndash Severe obesity BMI gt40

bull Fat distribution - waist circumference

bull Children and adolescents ndash percentilesndash Overweight BMI = 85th-95th tile

ndash Obesity gt 95th tile

bull Severe obesity 120 of 95th percentile

BMI as a vital sign

Source Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Competency 90 Utilize evidence-based careservices for

people with obesity or at risk for obesity

bull 91 Identify credible information to support obesity care

bull 92 Evaluate BMI and other anthropometric measures routinely

bull 93 Identify physical and psychosocial comorbidities and their potential impact on the health of the individual

bull 94 Engage relevant health professionals to initiate a comprehensive care plan using shared decision-making within the personrsquos context

bull 95 Identify access-to-care barriers for patients with obesity and solutions to mitigate those barriers

bull 96 Employ evidence-based individual and family behavioral-change strategies such as motivational interviewing and cognitive behavioral therapy

Measurement of Obesity

bull Body mass index (wt in kgheight in m2)ndash Overweight BMI = 25-299

ndash Obesity BMI gt 30

ndash Severe obesity BMI gt40

bull Fat distribution - waist circumference

bull Children and adolescents ndash percentilesndash Overweight BMI = 85th-95th tile

ndash Obesity gt 95th tile

bull Severe obesity 120 of 95th percentile

BMI as a vital sign

Source Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Measurement of Obesity

bull Body mass index (wt in kgheight in m2)ndash Overweight BMI = 25-299

ndash Obesity BMI gt 30

ndash Severe obesity BMI gt40

bull Fat distribution - waist circumference

bull Children and adolescents ndash percentilesndash Overweight BMI = 85th-95th tile

ndash Obesity gt 95th tile

bull Severe obesity 120 of 95th percentile

BMI as a vital sign

Source Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Source Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

USPSTF guidelines related to obesity

Childrenadolescents

bull Screen for obesity for those

6 years and above

bull Offer or refer for

interventions for those with

obesity

bull Comprehensive intensive

behavioral interventions (26

+ contact hours)

bull B recommendation

bull USPSTF JAMA 2017

Adults

bull Screen for obesity for adults

bull Offer or refer for

interventions for those with

obesity (BMI gt= 30)

bull Intensive multicomponent

behavioral interventions

(12-26 sessions)

bull B recommendation

bull USPSTF Annals IM 2012

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Take home messages1 Obesity is a chronic disease and a major

health issue in the US

2 Obesity reflects the inequities in the US health system

3 Obesity requires a cross sector interprofessional prevention and treatment approach

4 We have an evidence base for what works and multiple resources for implementation

5 Bias and stigma are a major issue in dealing with obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Durham resources

bull ShapeNC httpwwwsmartstartorgshape-nc-home

bull Partnership for a Healthy Durham httphealthydurhamorgndash 2016 Durham State of the County Health Report

httphealthydurhamorgcmswp-contentuploads2016032016-SOTCH-03022017-PRINT-FINALpdf

ndash Obesity and Chronic Disease Committee httphealthydurhamorgcommitteesobesity-and-chronic-illness-committee

bull The Duke Endowment- Bull City Fit httpdukeendowmentorgstoryhelping-communities-reduce-childhood-obesity

Duke Resourcesbull Duke Diet and Fitness Center httpswwwdukedietandfitnessorg

bull Duke Department of Pediatrics httpspediatricsdukeedudivisionshealthy-lifestyles

bull Duke Center for Metabolic and Weight Loss Surgery httpswwwdukehealthorglocationsduke-center-metabolic-and-weight-loss-surgery-durham-clinic

bull Duke Global Health Sciences Center httpwwwdukedigitalhealthorgabout-usprograms

bull Duke World Food Policy Center httpssanforddukeeduarticlesplanning-food-policy-center-duke-university

bull Duke Obesity Prevention Program httpchpirorg_homepage-contentresearchdopp

bull Duke Global Heath httpglobalhealthdukeedutopicsobesity

bull DCRI httpsdcriorgaha-childhood-obesity

References for obesitybull Trends in Obesity Prevalence Among Children and Adolescents in the

United States 1988-1994 Through 2013-2014 Ogden CL Carroll MD Lawman HG Fryar CD Kruszon-Moran D Kit BK Flegal KM JAMA 2016 Jun 7315(21)2292-9

bull Prevalence of Obesity Among Adults and Youth United States 2011-2014Ogden CL Carroll MD Fryar CD Flegal KM NCHS Data Brief 2015 Nov(219)1-8

bull Trends in Obesity Among Adults in the United States 2005 to 2014 FlegalKM Kruszon-Moran D Carroll MD Fryar CD Ogden CL JAMA 2016 Jun 7315(21)2284-91

bull Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life Zheng Y Manson JE Yuan C Liang MH Grodstein F Stampfer MJ Willett WC Hu FB JAMA 2017 Jul 18318(3)255-269

bull Obesity and Excessive Weight Gain in Young Adults New Targets for Prevention Dietz WH JAMA 2017 Jul 18318(3)241-242 doi 101001jama20176119

bull Obesity and socioeconomic status in children and adolescents United States 2005-2008 Ogden CL Lamb MM Carroll MD Flegal KM NCHS Data Brief 2010 Dec(51)1-8

bull Obesity and socioeconomic status in adults United States 2005-2008Ogden CL Lamb MM Carroll MD Flegal KM NCHS Data Brief 2010 Dec(50)1-8

References for obesity (2)bull An Integrated Framework For The Prevention And Treatment Of Obesity

And Its Related Chronic Diseases Dietz WH Solomon LS Pronk N Ziegenhorn SK Standish M Longjohn MM Fukuzawa DD Eneli IU Loy L Muth ND Sanchez EJ Bogard J Bradley DW Health Aff (Millwood) 2015 Sep34(9)1456-63

bull IOM (Institute of Medicine) 2015 Examining a developmental approach to childhood obesity The fetal and early childhood yearsWorkshopsummary Washington DC The National Academies Press

bull httpswwwuspreventiveservicestaskforceorgPageDocumentdraft-recommendation-statement165obesity-in-children-and-adolescents-screening1

bull httpswwwuspreventiveservicestaskforceorgPageDocumentUpdateSummaryFinalobesity-in-adults-screening-and-management

bull The Challenge of Treating Obesity and Overweight Proceedings of a Workshopmdashin Brief 2017 httpswwwnapedudownload24830

bull Patients preferred terms for describing their excess weight discussing obesity in clinical practice Volger S Vetter ML Dougherty M Panigrahi E Egner R Webb V Thomas JG Sarwer DB Wadden TA Obesity (Silver Spring) 2012 Jan20(1)147-50 doi 101038oby2011217 Epub 2011 Jul 14

bull Motivating or stigmatizing Public perceptions of weight-related language used by health providers Puhl R Peterson JL Luedicke J Int J Obes(Lond) 2013 Apr37(4)612-9 doi 101038ijo2012110 Epub 2012 Jul 10 Erratum in Int J Obes (Lond)2013 Apr37(4)623

References for competencies

bull Toward a common taxonomy of competency domains for the health professions and competencies for physiciansEnglander R Cameron T Ballard AJ Dodge J Bull J Aschenbrener CA Acad Med 2013 Aug88(8)1088-94

bull Competency-based medical education theory to practiceFrank JR Snell LS Cate OT Holmboe ES Carraccio C Swing SR Harris P Glasgow NJ Campbell C Dath D Harden RM Iobst W Long DM Mungroo R Richardson DL Sherbino J Silver I Taber S Talbot M Harris KA Med Teach 201032(8)638-45

bull Competent to collaborate towards a competency-based model for interprofessional education Barr H Journal of Interprofessional Care 199812(2)181-187

bull httpscdnbipartisanpolicyorgwp-contentuploads201706Provider-Competencies-for-the-Prevention-and-Management-of-Obesitypdf