Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117007

Roy Grant¹, Sandra Goldsmith, MS, RD¹, Marian Larkin, MD², and Alan Shapiro, MD². (1) The Children's Health Fund, 317 East 64th Street, New York, NY 10021, 212-535-9400, rgrant@chfund.org, (2) Children's Hospital at Montefiore, Albert Einstein College of Medicine, 871 Prospect Ave., Bronx, NY 10459

Obesity (BMI => 95th percentile) more than doubled from 1980-2000 among children 6-11 years old and tripled for adolescents 12-19. Associated health conditions including type 2 diabetes (T2DM) and incipient cardiovascular disease (CVD) also increased. Black and Hispanic children and youth are disproportionately affected. Nutrition and other weight management interventions are reimbursed by third party payors only if there is a “co-morbid” condition (e.g., T2DM). This is incompatible with the goals of health promotion and disease prevention. We sought to develop criteria to identify patients at highest risk for health conditions related to overweight and obesity for whom nutrition services could be reimbursed as medically necessary. Preliminary data from patients (N=75) identified with a screening algorithm developed for use at comprehensive physical examinations reveal: 71% Hispanic, 29% black; 56% male; mean age, 14.7 years; 91% obese, 9% overweight (BMI 85th - 94th percentile), mean BMI, 33.5; 87% family history of diabetes; 70% acanthosis nigricans; 35% dyslipidemia; 24% elevated blood pressure. We suggest a constellation of these factors defines this highest risk (“adolescent obesity syndrome”) patient group. Based on retrospective chart review of 200 patients 6-19 years old in our South Bronx Health Center serving a predominantly Hispanic community: 19% are overweight, 21% obese but do not meet highest risk criteria, and 4% are at highest risk. The latter comprise a small patient group for whom nutrition/weight management interventions could be reimbursed. We suggest such reimbursement could be cost effective based on the cost of direct diabetes care (19% of total U.S. personal health expenditures for 4.2% of population).

Learning Objectives: At the end of this presentation, participants will

• Better understand the need for reimbursement of nutrition services prior to a diagnosis of diabetes, cardiovascular disease, other other potentially weight related condition;
• Better conceptualize the factors that could constitute medical necessity for adolescent patients who are overweight and obese;
• Have additional information about how such patients may be identified in primary care settings.

Keywords: Obesity, Health Disparities

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Handout (.ppt format,

Handout (.doc format,