" Nutritional Resources & ACO Standards How do they Intersect?" August 2015

Transcription

1 " Nutritional Resources & ACO Standards How do they Intersect?" August 2015

2 Chat box feature Chat Box is available to you to ask questions or make comments anytime throughout today s webinar. Submit to Host and click the send button

3 ACO Announcements Reminders: May Specialty meetings-video available ACO Notifications Save the date 9/22/2015 Primary care meeting

4 Agenda ACO Adult Weight Screening and follow up measure Epidemic why? Weight management approaches Resources available Q&A section

5 Obesity Epidemic By 2010, in the United States, 35.7% of adults were obese, and another 33.1% were overweight. Obesity rates have doubled worldwide since 2010 Without any change, by 2030 nearly 45% of Americans will be obese, and 13 states will have an adult obesity rate of over 60%. Aligning Communities-How Four Cities are Preventing Obesity US Chamber of Commerce Corporate Citizenship Center,

6 Obesity in Western New York Obesity and Related Illnesses: Erie County The percentage of Erie County adults who are overweight or obese is 64.8%, which is higher than the New York State rate (60%). Nearly 30% are obese. As illustrated in the chart, Erie County s adult obesity rate is higher than in New York State but lower than in the rest of the country. hac/general/g75.htm Erie County Community Health Assessment , www2.erie.gov/health/sites/www2.erie.gov.health/files/.../pdfs/cha.pdf

7 Quality Measurement: Domains 33 quality measures are separated into the following four key domains that will serve as the basis for assessing, benchmarking, rewarding, and improving ACO quality performance: 1. Patient/Caregiver Experience 2. Care Coordination/Patient Safety 3. Preventive Health 4. Clinical Care for At Risk Population

8 ACO Preventive Health Domain Measure Name 14 Preventive Health Influenza Immunization 15 Preventive Health Pneumococcal Vaccination 16 Preventive Health Adult Weight Screening and Follow-up 17 Preventive Health Tobacco Use Assessment and Tobacco Cessation Intervention 18 Preventive Health Depression Screening 19 Preventive Health Colorectal Cancer Screening 20 Preventive Health Mammography Screening 21 Preventive Health Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding years

9 PREV-9: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Description Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter Normal Parameters: Age 65 years and older BMI 23 and < 30 Age years BMI 18.5 and < 25 What are the DOCUMENTATION REQUIREMENTS relative to the Quality Action? The patient s medical record must contain: BMI screening date and results; and If a follow-up plan is required, documentation of discussion of the plan. The follow-up plan must be specified as an intervention that pertains to the BMI outside of normal parameters " Quality Measure and Performance Standards". Available online at Payment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015

10 PREV-9: BMI Assessment and Follow-Up WHEN must the Quality Action be performed? The BMI screening may take place during the most recent visit within the measurement period or within the 6 months prior to that visit. If a follow-up plan is needed, it must be documented during the visit in which the abnormal BMI is documented. Guidance Follow-up may include, but is not limited to: documentation of education, referral (such as, a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), pharmacological interventions or dietary supplements, exercise counseling or nutrition counseling Follow-up plan is not required for normal BMI " Quality Measure and Performance Standards".Available online at Payment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015

11 ADULT WEIGHT SCREENING

12 Body Mass Index (BMI) Weight Screening BMI Weight Status Below 18.5 Underweight Normal or Healthy Weight Overweight 30.0 and Above Obese

13 Underweight Facts Underweight individuals: may be more prone to infection due to weak and easily compromised immune systems tend to have low muscle mass, hair loss, and in some cases disrupted hormone regulation may have disruptions in intake and absorption of vital nutrients, including amino acids, vitamins, and minerals may be at increased risk of osteoporosis and anemia

14 Causes of Underweight Physical Genetics Illness wasting diseases, medication side effects Psychological Eating disorders Stress

15 Obesity Facts More than one-third (34.9% or 78.6 million) of U.S. adults are obese Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars The medical costs for people who are obese were $1,429 higher than those of normal weight

16 Causes of Overweight/Obesity Lack of energy balance calories in vs. out Genetics Health conditions/ medication side effects Inactive lifestyle Environment

17 Treatment Approaches Coordination of interdisciplinary team Structured diet and physical activity Setting realistic goals Based on individual s wants and needs

18 Addressing the Weight Issue Set an effective tone for communication Assess patient s readiness/ motivation Build a partnership with the patient

19 Set an Effective Tone for Establish rapport Communication Communicate a non-judgmental attitude Address your patient s main health concerns first Solicit permission Ask the patient if they are comfortable discussing their weight Use preferred terms weight, unhealthy body weight, BMI

20 Assess the Patient s Readiness/ Motivation Reasons and motivation to lose/ gain weight Previous attempts at weight loss/ gain Support from family and friends Understanding of risks and benefits Attitudes toward health behaviors Potential barriers

21 Build a Partnership with the Patient Ask patients how ready they are to adopt healthier eating/ exercise habits Work as a partner to develop a plan 2-3 specific, realistic goals Some questions to ask: What are your goals regarding your weight? What kind of changes would you be willing to start with? What kind of help would you like from me about your weight?

22 Helping Patients Stick with Goals Acknowledge patients progress Offering praise can help boost self-esteem and keep them motivated Note changes in related risk factors, not just weight Blood sugar, BP, cholesterol Discuss any setbacks Help them overcome challenges and set new goals

23 Insurance Resources Many companies will pay for health/ fitness related expenses Gym memberships Silver Sneakers Insurance reimbursement for Medical Nutrition Therapy (MNT)

24 Insurance Coverage - Medicare Medical Nutrition Therapy CPT Codes 97802, 97803, Covered for beneficiaries with DM, Renal Disease, or Kidney Transplant in past 3 years Covered for 3 hours total in first year, 2 hours in later years Covered with $0 copay

25 Insurance Coverage - Medicare Intensive Behavioral Therapy for Obesity RDs may not bill directly for this service may provide service if billed incident to a physician service HCPCS code G0447 Covered for: 1 visit per week in month 1 1 visit every other week for months 2-6 (patient must have lost 3kg at 6 months to continue) 1 visit every month for months 7-12 Covered with $0 Copay

26 Insurance Coverage Managed Very individualized IHA Medicare Medicare Most plans all diagnoses, no visit limits, $0 copay (some self funded PCP level copay) BC/BS Medicare Advantage Some plans only cover Diabetes, others cover MNT

27 Catholic Health Resources CMP In-office Nutrition Program Catholic Health Nutrition Services

28 In-office Nutrition Program RD sees patients within physician s office One-on-one nutrition counseling Group classes Services billed directly to patient s insurance For patient s without nutrition coverage office can set their own cash price RDs chart directly into EMR

29 Catholic Health Nutrition Services Private nutritional counseling services are available by appointment at several locations Before You Make Your Appointment: To receive counseling, you must have a prescription or referral from your doctor indicating your diet order and diagnosis code Check with your insurance carrier determine coverage If your insurance plan does not cover this service, you will be billed

30 Catholic Health Nutrition Services Kenmore Mercy Hospital 2950 Elmwood Avenue Kenmore, NY Mount St. Mary's Hospital 5300 Military Road Lewiston, NY Mercy Comprehensive Care Center 397 Louisiana Street Buffalo, NY OLV Family Care Center 227 Ridge Road Lackawanna, NY Mercy OB/GYN Center 515 Abbott Road Suite 302 Buffalo, NY Sisters of Charity Hospital 2157 Main Street Buffalo, NY St. Joseph Campus 2605 Harlem Road Cheektowaga, NY 14225

31 Community Resources Stay Fit Dining (Erie County) Eat Well Stay Well (Niagara County) Meals on Wheels Niagara County Home Delivered Meals Tops Market Grocery Delivery Services Food Pantries/ Soup Kitchens

32 Stay Fit Dining Erie County s congregate dining program. Includes nutritious hot lunch meals, providing 1/3 of vitamin, mineral, and protein requirements for people >60 years old. Locations also offer free nutrition counseling and education by a registered dietitian.

33 Stay Fit Dining Many Stay Fit Dining sites offer Group Senior Fitness exercise programs

34 Stay Fit Dining The program is open Monday Friday Must be 60 years of age or older Advanced reservations are required Suggested confidential contribution of $3, but no one is denied a meal if they are unable to contribute

35 Stay Fit Dining This program is brought to you by the Erie County Department of Senior Services (716) To Find out more about the program or a site near you, call (716) q=nutrition-amp-dining-stay-fit-dining-program

36 Stay Fit Dining Program Locations Akron-Newstead Sr. Citizen 5691 Cummings Rd., Akron Exercise, Exercise Classes, Cards, Social Events, Speakers Alden Community Center Main St., Alden Social Events, Bingo, Cards, Transprt To Shop. Mall Trips (T, W & R only) Amherst Senior Center 370 John James Audubon Pkwy., Amherst Exercise, Travel Club, Social Events, Classes Autumnwood Senior Center 1800 Clinton St., Buffalo Aerobics, Exercise Classes, Exercise Equipment, Entertainment

37 Stay Fit Dining Program Locations Baptist Manor (Senior Apartments) 276 Linwood Ave., Buffalo Exercise Classes, Meditation, crossword puzzles, walking program, bible study, PACE program, guest speakers, movies, weights The Belle Center 104 Maryland Ave., Buffalo x35 Shopping, Transportation, Bingo, Exercise, Swimming Pool Blasdell (Lilly Housing Dev.) 36 Arthur Ave., Blasdell Exercise Classes, Painting & Craft Classes, Social Clubs Boston Senior Citizen Center 8500 Boston State Rd., Boston Bingo, Exercise Classes, Pool Table, Arts & Crafts, Cards

38 Stay Fit Dining Program Locations Buffalo Urban League 86 Pine St., Buffalo Exercise Classes, Travel, Picnics, Arts & Crafts Cayuga Village Apartments 100 Hutchens Dr., Cheektowaga Bingo, Cards, Parties Cheektowaga Senior Center 3349 Broadway, Cheektowaga Cafeteria style lunch daily at noon, fun activities all the time! Clarence Senior Citizen Center 4600 Thompson Rd., Clarence Ceramics, Yoga, Cards, Exercise Classes, Social Events Concord Nutrition Site 405 West Main Street, Springville Holiday Parties

39 Stay Fit Dining Program Locations Edward Saunders Community Center/CAO 2777 Bailey Ave., Buffalo Exercise classes, Movie night, Line Dancing, and more! Friends to the Elderly 118 E. Utica St., Buffalo Gloria Parks Community Center 3242 Main St., Buffalo x226 Line Dancing, Swimming, Exercise Classes Hamburg Dining Site (Creekbend Heights Apartments) 25 Buffalo St., Hamburg Exercise Classes, Church Service, Bingo Hispanics United of Buffalo 254 Virginia St., Buffalo, NY Music, Dancing, Games & Crafts

40 Stay Fit Dining Program Locations

41 Stay Fit Dining Program Locations Infant of Prague 921 Cleveland Dr., Buffalo / Bingo, Social Functions, Cards Kenmore Senior Nutrition Program 135 Wilber Ave., Kenmore, NY Lots of activities in bright and cheerful setting - plenty of parking, Van for shopping, Exercise Classes Lackawanna Senior Center 230 Martin Rd., Lackawanna Exercise Classes, Line Dancing Lancaster Senior Center 100 Oxford Pl., Lancaster Games, Travel, Computer Classes, Bingo, Cards/ Pinochle Maryvale East Senior Complex (Moorman) 100 Moorman Dr., Cheektowaga Bingo, Parties, Cards & Dinner

42 Stay Fit Dining Program Locations Moot Senior Center 292 High St., Buffalo Table Games, Bingo, Card Club, Exercise, Exercise Classes, Chorus, Bowling, Bible Study, Crafts North Buffalo Community Center 203 Sanders Rd., Buffalo ext. 14 Bingo, Cards, Line Dancing, Swimming, Exercise Classes Northwest Buffalo Community Center 155 Lawn Ave., Buffalo , X17 Exercise, Bingo, Cards, Social Events, Swimming, Ceramics, Crafts Orchard Park Senior Center 70 Linwood Ave., Orchard Park Weight Management, Yoga, Dancing, Exercise, Pool Tables, Crafts, Trips, Computer Classes

43 Stay Fit Dining Program Locations Salvation Army Headquarters 960 Main St., Buffalo , ext 259 Free Chiropractic Treatments, Arts & Crafts, Exercise Rm., Trips Salvation Army-Tonawanda Branch 46 Broad St., Tonawanda Free Breakfast Tues &Thurs, Bible Study, Social Events, Exercise, Bingo Schiller Park Senior Center 2057 Genesee St., Buffalo Exercise Classes, Line Dancing, Movies Seneca Babcock Community Center 1168 Seneca St., Buffalo,NY Cards, Wednesday Bingo, fitness program with state of the art equipment, ceramics, computer room, occasional trips Sloan Senior Center 140 Halstead St., Sloan Bingo, Exercise Classes, Pokeno, Raffles, Social Events

44 Stay Fit Dining Program Locations Southwind Landing 5074 Transit Rd., Depew Affordable senior housing units managed by Belmont Shelter Corp. Tosh Collins Center 35 Cazenovia Ave., Buffalo Bingo, Ceramics, Cards, Travel Town of Aurora Senior Center 101 King St., Suite A, East Aurora, NY Exercise, Computers, Ceramics, Fitness Center, Yoga, Tai Chi, Cards, Movies, Trips Town of Evans Senior Center 999 Sturgeon Rd., Derby, NY Bingo, Cards, Billiards, Theme Parties, Exercise, Line Dancing, Trips Town of Hamburg Sr. Ctr Sowles Rd., Hamburg For info call

45 Stay Fit Dining Program Locations United Church Manor 50 North Ave., West Seneca Tai Chi, Bingo, Tea Socials Violet Housing Complex 11 Haley Lane Ckeektowaga Bingo, Cards, Club 99 Exercise Classes Walden Park Senior Complex 101 Bakos Dr., Buffalo Bingo, Shopping, Travel West Seneca Senior Center 4620 Seneca St., West Seneca Dance, Exercise Classes, Fitness Center, Bingo, Tai Chi, Trips, Arts & Crafts, Ceramics William-Emslie Senior Center 585 William St., Buffalo Social Events, Games, line dance, fitness, state of the art exercise equip., Olympic size swimming pool, cards, travel, social, ceramics, knitting, sewing

46 Stay Fit Dining Program Locations

47 Eat Well Stay Well Program Niagara County s congregate dining program for seniors. For adults 60 years of age and older, as well as their spouse, as well as disabled, dependent child of any age Contact the nutrition site between 10am-1pm Monday through Friday, and make reservations at least 24 hours in advance to order a meal

48 Eat Well Stay Well Program Site Locations: Contact Niagara County Office of the Aging (716) or (716) Contributions are recommended, but not mandatory - $3 per meal for persons over 60, $4 per meal for persons under 60.

49 Niagara County Nutrition Assessment, Education, and Counseling Program Individual nutrition assessment and counseling on any topic and for individuals with chronic diseases such as: diabetes, heart disease, hypertension, chronic obstructive pulmonary disease, renal disease, malnutrition, weight reduction or weight gain, cholesterol, etc. Group educational programs are also available Group counseling can be in-home, at the Office for the Aging or at any nutrition site location

50 Niagara County Nutrition Assessment, Education, and Counseling Program Must be 60 years of age or older, proof of age will be required Transportation may be available for some site locations Free service, donations are excepted 8am-4pm Mon-Fri Call Niagara County Office for the Aging at (716) for more information

51 Congregate Dining Sites Chautauqua County The Taft Center (ADC) Christ First United Methodist Church 663 Lakeview Avenue, Jamestown (716) Chautauqua Colony Apartments 2109 Southwestern Drive, Lakewood First United Methodist 3594 Church Street, Kennedy (716) (OFA)

52 Congregate Dining Sites Chautauqua County Dunkirk Senior Center 45 Cliffstar Ct., Dunkirk Fredonia Dining Site 32 Moore Street, Fredonia Dunkirk/North County ADC Center St. John's United Church of Christ 733 Central Avenue, Dunkirk (716) Steger Apts 15 North Main Street, Dunkirk

53 Congregate Dining Sites Chautauqua County Forestville Fire Hall 18 Chestnut Street, Forestville Portage Hill Apartments 40 Evans Street, Mayville (716) Herbert Star Apartments 54 Central Avenue, Brocton (716) (OFA) Westfield YWCA 58 South Portage St, Westfield (716)

54 Congregate Dining Sites Chautauqua County Findley Lake Comm. Bldg North Road, Findley Lake (716) Westfield Adult Day Care Center 58 South Portage, Westfield (716) Sinclairville Fire Hall 30 Main Street, Sinclairville (716)

55 Meals On Wheels (MOW) An option for patients 60 years of age and older, and are unable to take care of meal preparation Call Erie County Department of Senior Services at (716) to set up a free inhome evaluation

56 Meals On Wheels (MOW) Once it is determined the patient qualifies for home delivered meals, they will also be evaluated for any other services or benefits they may be eligible for A doctor s note indicating a specific diet is required (ie. Low Salt, Diabetic, etc.)

57 Meals On Wheels (MOW) Volunteers deliver 2 meals mid-day Monday through Friday: lunch and dinner Menus are planned by registered dietitians and provide 2/3 of RDA nutritional requirements A confidential contribution of $3.50/meal ($7.00/day) is suggested to maintain the meal program, but no one is denied meals if they are unable to contribute

58 MOW of WNY Locations Served Buffalo, Lackawanna, Angola, Brant, Derby, Evans, Eden, Hamburg, Farnham, N. Collins, Collins, Clarence, Akron, Newstead, Lancaster, Depew, Cheektowaga, Sloan, West Seneca, Orchard Park, Elma, East Aurora, South Wales, parts of Marilla, parts of Amherst, Williamsville, Snyder, Boston, Colden, Concord, Holland, parts of Sardinia

59 Other MOW Contacts Amherst MOW: (716) Ken-Ton MOW: (716) Alden MOW: (716) North Tonawanda MOW: (716) Also serves City of Tonawanda East Aurora Portable Meals (village only): (716) Grand Island MOW: (716)

60 Niagara Co. Home Delivered Meals For home-bound individuals who are unable to provide meals for themselves Must be 60 years of age and older Phone screening and a full assessment by the county are required Call Niagara County Office for the Aging (716)

61 Niagara Co. Home Delivered Meals Contributions are recommended but not mandatory - $2.50 per meal Hours of operation are 6am-2pm Mon-Fri

62 Tops Market Home Delivery Services: Dimino s Dimino s Lewiston Tops Market 906 Center St., Lewiston, NY, Orders taken 8am-2pm Mon-Fri, deliveries 8am- 4pm Mon Fri They will shop for and deliver your groceries Must be a resident of Lewiston, Youngstown, Ransomville, Porter, or Deveaux

63 Tops Market Home Delivery Services: Dimino s For more info or to set up service, call (716) Shopping service fee is 10% of total bill Delivery fee can range from $3-$8 depending on location of delivery Private Pay (cash, check, credit)

64 Tops Market Home Delivery Services: Perna Family Perna Family Lockport Tops 5827 South Transit Rd, Lockport, NY, Orders taken between 8am and 12pm Mon-Fri, deliveries are between 11am-4pm Mon-Fri Order your groceries in the morning for delivery that afternoon

65 Tops Market Home Delivery Service: Perna Family Must reside in city or town of Lockport, Wrights Corners, or Pendleton Delivery fee is based on distance from store. Will be waived for orders over $50 before shopping service fee Shopping service fee is 10% of total bill Private pay (cash, check (must be approved), credit, benefit card) Call (716) or (716) for more info or to set up service

66 Food Pantries/Soup Kitchens If you know someone in need, call the Department of Intake and Assistance (716) They will direct you to the nearest food pantry, dining room/soup kitchen, or assist with other programs conducted by the Salvation Army, Catholic Charities, and Federal Nutrition Programs (WIC, SNAP).

67 Food Pantries/Soup Kitchen There are over 160 pantries/soup kitchens in the WNY Food for All pantry locator: Locator.aspx

68 EMR Documentation

69 EMR Documentation Preventive Medicine Counseling Care Goal Follow up plan Answer question(s)

70

71 QUESTIONS??

72 Announcements Next Lunch & Learn: 9/16/2015 Topic: "Medicare Annual Wellness Visit- What should be documented?" Reminders: May Specialty meetings-video available ACO Notifications Sheree M Arnold ACO Clinical Transformation Specialist sarnold@chsbuffalo.org (716)

73 Lifeskills Diabetes Self-Management Education Program Recognized by the American Diabetes Association* 2015 Schedule and Registration Form chsbuffalo.org

74 Lifeskills Diabetes Self-Management 4-Part Education Program Recognized by the American Diabetes Association Education is the key to successfully managing your diabetes. You are the most important member of the diabetes management team. We will provide you with the knowledge and skills to control your blood sugar and live a healthy life. This is a 4-part education program. Attendance at all 4 classes is recommended. What Will I Learn What is Diabetes? Nutrition & Meal Planning Exercise & Physical Activity Medications Self Blood Glucose Monitoring Dealing with High & Low Blood Sugars Attend This Program If You Are Recently Diagnosed with Diabetes Changing your Treatment or Nutrition Plan Having Difficulty Controlling your Diabetes Avoiding Long-term Complications Foot Care Goal Setting & Problem Solving Emotional Adjustment & Stress Management Healthy Lifestyle Changes Who Will Teach the Classes Specialists in diabetes education including certified diabetes educators, registered nurses, registered dieticians, physical therapists, and podiatrists. Important Points Your physician will be contacted to complete the required referral form. A family member or friend may attend with you at no additional cost. If you need specific assistance, please let us know when you register. Program sites are handicapped accessible. Additional Services Call HealthConnection at (716) for details. Individual Instruction available for: Insulin administration Home blood glucose testing Gestational diabetes A prescription from your doctor is necessary for this service. Those with Medicare must have a physician referral. Continuing Your Journey An optional follow-up session Available for those who attended Lifeskills Diabetes Self-Management classes I registered for a Diabetes Education class at Facility which will be held on. Dates

75 2015 Diabetes Education Classes Registration Form 1. Please complete the form below and check the box next to the class session you wish to attend and in which you would like to enroll. 2. Submit the completed form to one of the following: Mail: Catholic Health s HealthConnection Administrative & Regional Training Center 144 Genesee St., 5th Floor Buffalo, NY Fax: (716) HealthConnection@chsbuffalo.org 3. If you need payment assistance, please call (716) for information. Name: Last First Middle Date of Birth: Phone Number: Address: City: State: Zip: Marital Status: Race: Gender: Male Female Your Religion: Employer Name: Endocrinologist: Office Location: Primary Doctor s Name: Office Location: Emergency Contact Name: Emergency Contact Phone Number: Please check if someone will be accompanying you. Insurance Information No Insurance/Self Pay Primary Insurance: Policy Number: Group: Secondary Insurance: Policy Number: Subscriber: Subscriber s relationship to patient: Medicaid Number: Medicare Number: Plan: Subscriber s Employer: Confirmation of class registration will be mailed to you at the address you provide. Insurance As a courtesy to you, Catholic Health (Kenmore Mercy Hospital, Mercy Hospital of Buffalo, Sisters of Charity Hospital, and Sisters Hospital, St. Joseph campus) will bill your insurance company for the classes that you attend. If your insurance does not cover the cost of the class, you will receive a bill and will be responsible for applicable co-payments, co-insurance, deductibles, or for services not covered. Contact your insurance carrier to find out if they cover all or part of your cost. You may need to pay for the class and submit a receipt to your insurance carrier for reimbursement. Please remember to bring your photo ID and insurance card to class as a copy will be made.

76 Check the box next to the class session you wish to attend and in which you would like to enroll. Kenmore Mercy Hospital 2950 Elmwood Ave., Community Room Kenmore, NY February 3, 5, 10 & 1 p.m. March 17, 19, 25 & 6 p.m. April 14, 16, 21 & 1 p.m. May 12, 14, 19 & 1 p.m. June 2, 4, 9 & 1 p.m. July 21, 23, 28 & 6 p.m. August 11, 13, 18 & 1 p.m. September 15, 17, 22 & 1 p.m. October 6, 8, 13 & 1 p.m. November 10, 12, 17 & 6 p.m. December 1, 3, 8 & 1 p.m. Mercy Hospital of Buffalo Marian Professional Building - Lower Level l 515 Abbott Rd. Buffalo, NY January 14, 15, 21 & 9 a.m. February 4, 5, 11 & 9 a.m. March 4, 5, 11 & 9 a.m. April 29, 30, May 6 & 9 a.m. June 3,4, 10 & 9 a.m. August 12, 13, 19 & 9 a.m. September 9, 10, 16 & 9 a.m. November 4, 5, 11 & 9 a.m. December 2, 3, 9 & 9 a.m. Sisters of Charity Hospital 2157 Main St. Buffalo, NY January 7, 8, 14 & 9 a.m. April 8, 9, 15 & 9 a.m. July 8, 9, 15 & 9 a.m. October 7, 8, 14 & 9 a.m. Sisters of Charity Hospital, St. Joseph Campus 2605 Harlem Rd. Cheektowaga, NY January 6, 8, 13 & 2 p.m. February 16, 18, 23 & 9 a.m. March 3, 5, 10 & 2 p.m. April 20, 22, 27 & 6 p.m. June 15, 17, 22 & 9 a.m. August 17, 19, 24 & 9 a.m. September 21, 23, 28 & 6 p.m. November 30, December 2, 7 & 6 p.m. * The American Diabetes Association recognizes this education service as meeting the National Standards for Diabetes Self-Management Education. Catholic Health s Lifeskills program has been recognized by the American Diabetes Association for Quality Self- Management Education.

77 steps 3STEP ONE TO INITIATE DISCUSSION about weight management WITH YOUR PATIENTS Make the Most of the Patient Visit and Set an Effective Tone for Communication Patients who are overweight or obese generally have a history of dealing with a frustrating and visible problem. They often experience discrimination from strangers, and even hurtful comments from health professionals. Many patients however, are comfortable discussing weight with their physician 1. So setting an effective tone for communication is critical. Providers need to establish rapport with patients, solicit permission to discuss weight issues, and use preferred terms such as "weight," "excess weight," and "BMI" when describing obesity 2. Tips: Ask the patient if he/she would be comfortable with discussing general health including weight. Ask about the patient s weight history and how excess weight has affected his/her life. Be careful to communicate a nonjudgmental attitude that distinguishes between the weight problem and the patient with the problem. Express your concerns about the health risks associated with excess weight and how this is affecting the patient (review patient s BMI, waist circumference, and health risks). Effective treatment for obesity is based on skillful and empathetic communication between practitioners and patients. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute

78 STEP TWO Assess Patient s Motivation/Readiness to Lose Weight Evaluate the patient s readiness to make the necessary lifestyle changes to lose weight. This should include: reasons and motivation to lose weight, previous attempts at weight loss, expected support from family and friends, understanding risks and benefits, attitudes toward physical activity, and potential barriers. Tips: Ask patient if he/she would consider lifestyle changes to lose weight and improve health. Example: On a scale of 1-10, with 10 being 100 percent ready to take action, how ready are you to lose weight? An answer between 1-4 means the patient has very little intention to lose weight, so you could followup with "What would have to happen for you to be more ready?" or "What would it take to increase your score?" An answer between 5-7 means the patient is ambivalent about taking action to lose weight, therefore acknowledge the patients ambivalence in a nonjudgmental manner and invite the patient to bring up the subject at any time in the future. You could also followup with, "What would have to happen for you to be more ready?" or "What would it take to increase your score?" An answer between 8-10 means the patient is very willing to take action about his/her weight. Ask patient about previous attempts to lose weight. What were the most successful and least successful? Ask about the patient s physical activity level and attitude toward exercise. Ask patient about the level of support he/she can expect from family and friends. Ask about potential barriers to success.

79 WEIGH YOUR PATIENT S HEALTH RISKS Adults who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, and certain cancers. To determine your patient s relative risk for these diseases: 1. Calculate body mass index (BMI), by measuring weight relative to height. BMI = (Weight in pounds Height in inches Height in inches) x 703) or use the BMI Table on page 46 of the Practical Guide. 2. Measure waist circumference. 3. Use the table below to give you an idea of whether your patient s BMI combined with waist circumference increases his/her disease risks. CLASSIFICATION OF OVERWEIGHT AND OBESITY by BMI, Waist Circumference, and Associated Disease Risk* BMI (kg/m 2 ) Obesity Class Disease Risk* (Relative to Normal Weight and Waist Circumference) Men 40 in. ( 102 cm) Women 35 in. ( 88 cm) >40 in. (>102 cm) >35 in. (>88 cm) Underweight <18.5 Normal Overweight Increased High Obesity I High Very High II Very High Very High Extreme Obesity 40 III Extremely High Extremely High * Disease risk for type 2 diabetes, hypertension, and CVD. Increased waist circumference can also be a marker for increased risk even in persons of normal weight. Adapted from Preventing and Managing the Global Epidemic of Obesity Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997 A weight loss of 5-10 percent of initial weight will lower the risk of disease. See pages in the Practical Guide for a quick reference tool to help assess, classify, and treat (ACT) your overweight and obese patients.

80 STEP THREE Build a Partnership With the Patient Set goals for behavior change together with the patient. A recent study showed that most patients with a weight problem would like assistance with weight management, specifically dietary and physical activity advice, and help with setting realistic goals. Tips: Discuss the collaborative effort needed for setting goals. Ask what the patient s weight goals are. Explain that even a small weight loss of 10 percent of initial weight can lower health risks. Ask patient if he/she would like help with diet and physical activity. Select two or three measurable, achievable goals and discuss steps needed to achieve them. Provide and discuss patient handouts in The Practical Guide and/or refer patient to dietitian or exercise specialist. Sources: The NHLBI Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, NIH Publication No or Materials from the Centers for Obesity Research and Education (C.O.R.E.) Potter MB, Vu JD, Croughan-Minihane M. Weight management: what patients want from their primary care physicians. J Fam Pract 2001;50(6):513-8 Wadden TA, Anderson DA, Poter GD, et al. Obese women s perceptions of their physician s weight management attitudes and practices. Arch Fam Med 2000;9(9): NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute NIH Publication No November 2002