10/16/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING - PDF document

10/16/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING SLIDES FOR TODAY’S WEBINAR October 16, 2019 A Proposed Standard of Care for Adult Obesity www.villanova.edu/COPE Treatment for All Providers Click on Dietz/Gallagher webinar description page Moderator: Lisa Diewald, MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 1 2 DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? OBJECTIVES  Discuss the need for developing a standard of care of obesity If you are calling in today rather than treatment using your computer to log on, and need  Review the proposed standards of care for obesity treatment and CE credit, please email the research leading up to their development cope@villanova.edu and provide your name so we can send your certificate.  Identify how the proposed standards of care align with other obesity care guidelines, including obesity care competencies, development of an ideal benefit, and coverage for obesity treatment. Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 3 4 CE DETAILS CE CREDITS • This webinar awards 1 contact hour for nurses and 1 CPEU for Villanova University College of Nursing is accredited as a dietitians provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation • Suggested CDR Learning Need Codes: 5370, 5410, 6000, 9020 Villanova University College of Nursing Continuing • Level 2 Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration • CDR Performance Indicators: 4.2.8, 6.1.6, 6.3.11, 8.2.5 Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 5 6 1

10/16/2019 A Proposed Standard of Care for Adult Obesity Treatment DISCLOSURE for All Providers The planners of this program have no conflicts of interest to disclose. William H. Dietz, MD, PhD Dr. Dietz has disclosed a relationship with a commercial interest related to Chair, Sumner M. Redstone Center the content of this educational activity. The educational activity was Milken Institute of Public Health reviewed and approved by the Nurse Planner for balance in the presentation and evidence-based content and absence of bias was confirmed. Christine Gallagher, MPAff Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial Research Project Director products or medical/nutrition advice displayed in conjunction with an STOP Obesity Alliance activity. 7 8 Webinar Outline Proposed Standard of Care • Introduction to the STOP Obesity Alliance for Adult Obesity Treatment • Background for the proposed standard of care • Principles for all providers • Principles for clinical providers William H. Dietz MD, PhD Chair • The need for an essential obesity care benefit Sumner M. Redstone Center • Coverage 9 10 Stakeholders Working Together to Advance Weight-Related Issues Purpose and Goals • 15 Steering Committee Members • Purpose: Convene a diverse group dedicated to reversing the America’s Health Insurance Plans Gary Foster, PhD obesity epidemic in the United States American Diabetes Association National Business Group on American Heart Association Health • Goals: American Medical Group Association Obesity Action Coalition American Society for Metabolic Population Health Alliance  Lead Innovation & Bariatric Surgery The Obesity Society Donna Ryan, M.D. Trust for America’s Health  Strengthen systems of care  Convene diverse stakeholders • 60 Associate Member organizations  Define an innovative research agenda (chronic disease, consumer, minority health, & provider groups)  Promote strategies to increase physical activity  Reduce stigma to improve health outcomes • 4 Corporate Members 11 12 2

10/16/2019 Identified Gaps in Provider Knowledge of Patient-Provider Interactions Obesity Care is Limited TARGETS FOR IMPROVEMENT Among family practitioners, internists, OB-GYNs, and  Time is the most important barrier, but providers need tools nurse practitioners ( N = 1506 ): and programs  Only 39% of adults with a BMI ≥ 49% Knew that ≥ 150 mins/week of physical activity 30.0 recalled being told that they was necessary to achieve sustainable health have obesity by a HCP benefits  One - third of patients advised to lose weight were not given a plan to do so 33% Knew that any suitable eating pattern can be recommended for weight loss (NHLBI guideline )  Most PCPs say no one in their practice has been trained to deal with weight issues 16% Knew that 12-26 sessions during the first year is  Follow-up appointments are not the recommended for patients with obesity scheduled Turner et al. Obesity 2018; 26:665 13 14 Process for Developing a Standard of Care for Adult Obesity A Proposed Standard of Care Goal: provide a model of care for all those who care for people with obesity 2019 2018 • Core principles of care 2017 Proposed standard Three roundtable of care published meetings. Attendees • Standards of Care for all providers Steering Dietz, WH. and included over 50 committee Gallagher C,“A stakeholders, including • Standards of Care for clinical providers established and Proposed Standard health professionals who met in of Obesity Care for (prescribers) care for patients with All Providers and December obesity, community and Payers” Obesity ; • Coverage and payment policy standards non-clinic based 2019;27: 1059-1062. providers, payers, and patient advocates. 15 16 Effects of Bias and Stigma Core Principles of Care • Experience of bias and stigma increases with • Treat obesity as a chronic disease the severity of obesity • Care should be evidence-based pragmatic and deliverable • Provide access to appropriate level of care, regardless of • Provider attitudes - people with obesity are point of entry lazy, lack self-control, and are blamed for their • Providers should be sensitive to bias and provide appropriate obesity accommodation • Providers should be trained to initiate conversations about • Perceived provider bias affects quality of care weight and mistrust makes patients less likely to seek • Shared decision making and bidirectional communication care • Evidence-based competencies that are discipline-specific should be met by each type of provider 17 18 3

10/16/2019 Effects of Bias and Stigma Accommodations (cont.) • Provide wide-based, higher weight capacity chairs, preferably • Bias is internalized as self-blame armless, in patient areas • Offer large size or thigh-sized cuffs BP cuffs • Increased risk of depression, low self-esteem, and poor body image • Provide a higher capacity scale, ideally > 500 lbs • Locate scale in a private or near-private area to minimize • Increased exposure with more severe obesity anxiety and discomfort associated with being weighed • Wheelchair accessible bathrooms • Increased vulnerability to unhealthy behaviors that can contribute to weight gain • Install floor-mounted rather than wall-mounted toilets • Have extra-large gowns available • Educate staff about stigma and weight bias 19 20 People First Language Core Principles of Care • Treat obesity as a chronic disease • Overweight is a description • Care should be evidence-based pragmatic and deliverable • Provide access to appropriate level of care, regardless of • An “obese person” is an identity – he or she is obese, not a point of entry father, mother, or a person characterized by their achievements • Providers should be sensitive to bias and provide appropriate • An “obese person” is more likely to be held responsible tor accommodation their weight • Providers should be trained to initiate conversations about weight • Obesity is a disease • Shared decision making and bidirectional communication • Evidence-based competencies that are discipline-specific • Describing a person with obesity focuses attention on cause should be met by each type of provider 21 22 Efforts to Address Knowledge and Practice Gaps The Importance of Language Why Weight? Provider Guide Language to Use Language to Avoid Initiate open, productive Overweight Fat conversations about weight and health Increased BMI Obese Severe obesity Morbid obesity Assess patient readiness to change Unhealthy weight Healthier weight Engage in active listening Improved nutrition Diet (or dieting) Build trust Physical activity Exercise Establish realistic goals Address culture and social barriers and supports www.whyweightguide.org 23 24 4