5/23/ Click on Jeanne Blankenship webinar description page COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS

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1 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING SLIDES FOR TODAY S WEBINAR May 3, 218 Provider Competencies for the Prevention and Management of Obesity Click on Jeanne Blankenship webinar description page Moderator: Lisa Diewald MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education Nursing Education Continuing Education Programming Research DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? OBJECTIVES If you are calling in today rather than using your computer to log on, and need CE credit, please cope@villanova.edu and provide your name so we can send your certificate. 1. Describe the rationale for the development of the provider competences for the prevention and management of obesity. 2. Identify the top line competencies all across health care disciplines. 3. Recommend strategies for effective competency, dissemination and implementation. CE DETAILS CE CREDITS Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration The American College of Sports Medicine s Professional Education Committee certifies that Villanova University College of Nursing Continuing Education, Center for Obesity Prevention and Education (COPE) meets the criteria for official ACSM Approved Provider status (21-December, 218). Providership # This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians Suggested CDR Learning Need Codes: 32, 44, 37, 6 Level 2 1

2 PROVIDER COMPETENCIES FOR THE PREVENTION AND MANAGEMENT OF OBESITY DISCLOSURE Jeanne Blankenship, MS, RDN Vice-President, Strategy and Initiatives Academy of Nutrition and Dietetics Neither the planners or presenter have any conflicts of interest to disclose. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. Obesity: What all health professionals need to know Disclosures/acknowledgements Interprofessional Provider Training and Education partially funded by the Robert Wood Johnson Foundation Jeanne Blankenship, MS RDN Vice President, Policy Initiatives and Advocacy Changes in the Prevalence of Obesity among Youth 2-19 yo and Adults > 2 yo NHANES Changes in the Prevalence of Severe Obesity* in 2-19 yo Youth NHANES Year 4 3 Boys Girls Men Women Ogden 216 Flegal Year 9 8 Boys Girls * Severe obesity: BMI >12 of 9 th Percentile 2

3 Changes in the Prevalence of Severe Obesity (BMI > 4) in Adults NHANES Year 6 Men Women Flegal 216 Prevalence of Obesity in Selected Age Groups NHANES yo 6 11 yo 2 39 yo Ogden CL et al. NCHS Data Brief #219, November Demographics of People Who Gained > 2 kg between and (CARDIA) Ethnic Distribution of Obesity in 2-19 yo NHANES White Black NHW NHB Hispanic Men Women Boys Girls Lewis CE et al. Am J Epidemiol 2;11:1172 Ogden CL et al. NCHS Data Brief #219, November 21 Ethnic Distribution of Obesity in Adults NHANES Prevalence of obesity in adults by poverty income ration, sex, race and ethnicity: US NHW NHB Hispanic Men Women Ogden CL et al. NCHS Data Brief #219, November 21 Ogden 2 3

4 Adults with obesity by PIR, race and ethnicity. US 2-28 = not poor Epidemiology of obesity While the prevalence of obesity in children and adolescents has stabilized, the rate of severe obesity continues to increase The prevalence of obesity in adults continues to increase Increase in severe obesity is even greater The prevalence of obesity rises dramatically in early adulthood Ogden 2 Epidemiology of obesity African American and Hispanic populations are disproportionately impacted by obesity Among men, obesity prevalence is generally similar at all income levels, with a tendency to be slightly higher at higher income levels Among women, obesity prevalence increases as income decreases Most people with obesity are NOT poor Competency: An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes Since competencies are observable, they can be measured and assessed to ensure their acquisition Frank, JR et al Medical Teacher 2; 32(8): Provider Competencies for the Prevention and Management of Obesity Workgroup Co-Chairs: Don Bradley, M.D., MHS-CL Duke University William Dietz, M.D., Ph.D. George Washington University National Academy of Medicine (IOM) Roundtable on Obesity Solutions, Competencies-for-the-Prevention-and-Management-of-Obesity.pdf 4

5 Development framework Barr interprofessional competencies* 1. Common 2. Complementary 3. Collaborative *Barr 1998 **Englander, et.al 213 ***Bradley, Dietz, et.al 217 Englander health professions competencies** 1. Patient care 2. Knowledge for practice 3. Practice based learning and improvement 4. Interpersonal and communications skills. 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. Apply skills for interprofessional collaboration and clinical community integration 6. Use patient centered communication 7. Employ strategies to minimize bias towards and discrimination against people with obesity 8. Implement a range of accommodations and safety measures specific to people with obesity 9. Utilize evidence based care/services for people with obesity or at risk for obesity. Provide evidence based care/services for people with obesity comorbidities Organizations Engaged in the Development of Obesity Competencies (listed alphabetically) Academy of Nutrition and Dietetics Accreditation Council for Graduate Medical Education American Association of Colleges of Nursing American Association of Colleges of Osteopathic Medicine American Association of Colleges of Pharmacy American Board of Family Medicine American Board of Internal Medicine American Board of Pediatrics American Council of Academic Physical Therapy American Dental Education Association American Kinesiology Association American Psychological Association Association of American Medical Colleges Council on Social Work Education National Organization of Nurse Practitioner Faculties Physician Assistant Education Association YMCA of the USA Development Process 1. Define terms, scope, application 2. Identify and engage diverse stakeholders Obesity Competencies Three Broad Categories Core Obesity Knowledge 3. Collect health professions competencies 4. Draft competencies, iterative stakeholder review. Disseminate and pilot/incorporate competencies 6. Identify curricular resources 7. Periodic review and updates Interprofessional Obesity Care Patient Interactions Related to Obesity Care 28 Obesity Care Competencies Core Obesity Knowledge: 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 Interprofessional Obesity Care: 4. Describe the benefits of working interprofessionally to address obesity to achieve results that cannot be achieved by a single health professional. Apply skills necessary for interprofessional collaboration and integration of clinical and community care for obesity Obesity Care Competencies Patient interactions related to obesity care: 6. Use patient-centered communication when working with individuals with obesity and others 7. Employ strategies to minimize bias towards and discrimination against people with obesity, including weight, body habitus, and the causes of obesity 8. Implement a range of accommodations and safety measures specific to people with obesity 9. Utilize evidence-based care/services for people with obesity or at risk for obesity. Provide evidence-based care/services for people with obesity comorbidities

6 Expected Impact of the Obesity Care Competencies Provide support for the development and refinement of curricular materials and evaluation tools for the teaching and assessment of obesity care Support the development and refinement of faculty development programs for the teaching and assessment of obesity care Provide a common language for clinical experiences Competency.: Apply the skills necessary for effective interprofessional collaboration and integration of clinical and community care of obesity.1 Perform effectively in an interprofessional team.2 Promote the development and use of an integrated clinical-community care plan.3 Collaborate with community organizations to advocate for nutrition and physical activity services, programs, and/or policies that address obesity Interdisciplinary Specialist Certification in Obesity and Weight Management Current, valid certification as an: AANPCB Nurse Practitioner, ACSM Certified Exercise Physiologist, ACSM Certified Clinical Exercise Physiologist, ACSM Registered Clinical Exercise Physiologist, ANCC Nurse Practitioner, CDR Registered Dietitian Nutritionist, Licensed Clinical Psychologist, Licensed Clinical Social Worker, NCC Nurse Practitioner (WHNP-BC), NCCPA Physician Assistant, or PNCB Nurse Practitioner (CPNP-PC, CPNP-AC). 33 Competency 6.: Use patient-centered communication when working with individuals with obesity and others 6.1 Discuss obesity in a non-judgmental manner using people first language in all communications 6.2 Incorporate the environmental, social, emotional and cultural context of obesity into conversations with people with obesity 6.3 Use person- and family-centered communication (e.g. using active listening, empathy, autonomy support/shared decision making) to engage the patient and others Addressing Stigma and Bias Step 1: Use People First Language Using obese, dehumanizes individuals affected by this disease. Here are some examples of how to use People-First language: The woman was affected by obesity. instead of The woman was obese. The man with obesity was on the bus. instead of The man on the bus was very obese. With reframing, we re no longer labeling an individual with their disease. 3 Competency 9.: Utilize evidence-based care/services for people with obesity or at risk for obesity 9.1 Identify credible information to support obesity care 9.2 Evaluate BMI and other anthropometric measures routinely 9.3 Identify physical and psychosocial comorbidities and their potential impact on the health of the individual 9.4 Engage relevant health professionals to initiate a comprehensive care plan using shared decision-making within the person s context 9. Identify access-to-care barriers for patients with obesity and solutions to mitigate those barriers 9.6 Employ evidence-based individual and family behavioralchange strategies such as motivational interviewing and cognitive behavioral therapy 6

7 Measurement of Obesity Body mass index (wt in kg/height in m 2 ) Overweight: BMI = Obesity: BMI > 3 Severe obesity: BMI >4 Medical Complications of Obesity Fat distribution - waist circumference Children and adolescents percentiles Overweight: BMI = 8 th -9 th tile Obesity: > 9 th tile Severe obesity: 12 of 9 th percentile BMI as a vital sign? Source: Rudd Center for Food Policy and Obesity USPSTF guidelines Next Steps Children/adolescents Screen for obesity for those 6 years and above Offer or refer for interventions for those with obesity Comprehensive, intensive behavioral interventions (26 + contact hours) B recommendation USPSTF. JAMA 217 Adults Screen for obesity for adults Offer or refer for interventions for those with obesity (BMI >/= 3) Intensive, multicomponent behavioral interventions (12-26 sessions) B recommendation USPSTF. Annals IM Define terms, scope, application 2. Identify and engage diverse stakeholders 3. Collect health professions competencies 4. Draft competencies, iterative stakeholder review. Disseminate and pilot/incorporate competencies 6. Identify curricular resources 7. Periodic review and updates References for obesity Trends in Obesity Prevalence Among Children and Adolescents in the United States, Through Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. JAMA. 216 Jun 7;31(21): Prevalence of Obesity Among Adults and Youth: United States, Ogden CL, Carroll MD, Fryar CD, Flegal KM. NCHS Data Brief. 21 Nov;(219):1-8. Trends in Obesity Among Adults in the United States, 2 to 214. Flegal KM, Kruszon- Moran D, Carroll MD, Fryar CD, Ogden CL. JAMA. 216 Jun 7;31(21): 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. 217 Jul 18;318(3):2-269 Obesity and Excessive Weight Gain in Young Adults: New Targets for Prevention. Dietz WH. JAMA. 217 Jul 18;318(3): doi:.1/jama Obesity and socioeconomic status in children and adolescents: United States, Ogden CL, Lamb MM, Carroll MD, Flegal KM. NCHS Data Brief. 2 Dec;(1):1-8. Obesity and socioeconomic status in adults: United States, Ogden CL, Lamb MM, Carroll MD, Flegal KM. NCHS Data Brief. 2 Dec;():1-8. 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). 21 Sep;34(9): IOM (Institute of Medicine). 21. Examining a developmental approach to childhood obesity: The fetal and early childhood years:workshop summary. Washington, DC: The National Academies Press. /obesity-in-adults-screening-and-management References for competencies Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Acad Med. 213 Aug;88(8):88-94 Competency-based medical education: theory to practice. Frank 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. 2;32(8):638-4 Competent to collaborate: towards a competency-based model for interprofessional education. Barr H. Journal of Interprofessional Care. 1998:12(2): content/uploads/217/6/provider-competencies-for-the- Prevention-and-Management-of-Obesity.pdf 7

8 TO RECEIVE YOUR CE CERTIFICATE Questions and Discussion Jeanne Blankenship Look for an containing a link to an evaluation. The will be sent to the address that you used to register for the webinar. Complete the evaluation soon after receiving it. It will expire after 3 weeks. You will be ed a certificate within 2-3 business days. Remember: If you used your phone to call in, and want CE credit for attending, please send an with your name to cope@villanova.edu so you receive your certificate. 43 QUESTIONS & ANSWERS Moderator: Lisa K. Diewald MS, RD, LDN cope@villanova.edu Website: Villanova.edu/cope 8