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|Monday, April 26, 2010
|The Research Behind the Helen DeVos Children’s Hospital Healthy Weight Center
|by Pediatric Perspectives at 10:15 AM
Joe C. Eisenmann, PhD, Lead Researcher
Helen DeVos Children's Hospital Healthy Weight Center
The opening of the new Helen DeVos Children's Hospital Healthy Weight Center is exciting not just for overweight children and their families and doctors in West Michigan, but for myself and my new colleagues at the center. Together, we will provide a dynamic, multi-disciplinary approach.
Children referred to the center provide an important opportunity for research into the underlying genetic and environmental contributors to childhood obesity, the consequences of childhood obesity, and its assessment and treatment.
When not fulfilling my role as the lead researcher at the Healthy Weight Center, I direct the Biomarkers and Genetics Laboratory (BAGL) at Michigan State University.
Our primary focus is to better understand the genesis of childhood obesity and the metabolic syndrome during childhood and adolescence. The long-term goal of this research is to elucidate the mechanisms of the metabolic syndrome through the complex interactions of genetics, environmental factors (particularly stress, exercise, diet, and maternal factors), and the neuroendocrine, hormonal, metabolic, hemostatic and inflammatory systems in the growing and maturing obese child. As we know in so many other disease states, you cannot simply assume that the development of a disease in a child tracks identically with its development in an adult.
It is now becoming clearer that addressing the problem of obesity in children is not as simple as just reducing their caloric intake and increasing their physical activity. For instance, we found a significant inverse relationship between the amount of sleep and the incidence of overweight in adolescent boys, although we saw no such association in girls.
We have also found an association between maternal pre-pregnancy weight status and weight gain during pregnancy and offspring obesity. Most interesting is that we also found that children born to mothers who were obese during pregnancy but currently met physical activity recommendations still had a higher body fat than children born to mothers who were normal weight during pregnancy but currently did not meet physical activity recommendations. This finding has important implications for interpreting the results of child obesity programs.
We also found an association between a candidate gene that, together with environmental factors, may contribute to the metabolic changes seen in overweight children.
At the Healthy Weight Center, every patient who comes into the center is potentially a research subject. To that end, I helped develop the initial comprehensive screening and clinical protocols. In addition to the obvious-full physical examination, blood pressure, dietary history, etc.we will be assessing patient and family attitudes and belief about diet and physical activity.
We will also measure their habitual physical activity level objectively through the use of the SenseWear armband. This multi-sensor instrument is about the size of an MP3 player. It assesses body acceleration and temperature and uses an algorithm to estimate the child's energy expenditure on a minute-by-minute basis.
Not only will we know how much time a child spends in moderate and intense physical activity and sedentary pursuits, but we will be able to track it by time. So, for instance, inactivity around 3 p.m. (unrelated to homework) tells us we have a target time for activity. We might suggest the child take a walk or play a game with the neighborhood kids rather than playing video games. In addition, we will also be able to better match energy expenditure and energy intake.
In addition, we will collect resting metabolic rate and expired respiratory gases through a physical activity assessment tool to evaluate a child's efficiency of movement and maximal aerobic capacity. This will help in our exercise and nutrition counseling, and in our ability to understand the child's metabolic state at rest and during movement. We will also be using a family nutrition and physical activity screening tool I helped develop that assesses the shared family obesogenic environment.
Most importantly, my job is to evaluate what we're doing (assessment and treatment) see what is and isn't effective, and disseminate these results at national and international conferences and in peer-reviewed journals. Through our work at the center, we hope to further elucidate genetic aspects of child obesity and the response to diet, physical activity and, perhaps, pharmacologic treatment.
Although we have a host of hypotheses to be tested in the upcoming months, I will facilitate the multi-disciplinary team to develop additional hypotheses to test and will update important research findings related to childhood obesity on this blog.
What do you find working with your patients when it comes to managing their weight and other metabolic factors?
Joe C. Eisenmann, Ph.D. is the lead researcher at the Helen DeVos Children's Hospital Healthy Weight Center, and assistant professor in the departments of Kinesiology and Pediatrics and Human Development at Michigan State University in East Lansing. You can view more information on him and his work at http://eisenmann.wiki.educ.msu.edu/ and reach him at email@example.com.
|Thursday, April 15, 2010
|Health Care Reform is Law. Now What?
|by Pediatric Perspectives at 08:40 AM
Mark A. Lemoine
Director, System Government Affairs
Spectrum Health System
For the past year, most of my attention has involved keeping tabs on the various health care reform bills moving through Congress, focusing on what the different options could mean for Spectrum Health and Helen DeVos Children's Hospital.
Now that health care reform-or the Affordable Health Care For American's Act-is law. It might seem that my job is done.
The new law, as you probably know, is enormous. In addition, the bulk of its provisions-including mandated health insurance coverage for all Americans-don't kick in for several years. So what's in the bill and what actually gets put into action may look very different once the actual regulations are drafted. That means that the Department of Health and Human Services (HHS) has to create thousands of pages of new regulations.
So here in the Spectrum Health System Government Affairs office we will be keeping a very close eye on the regulatory process required to operationalize the new law. Furthermore, we will be monitoring how future legislation may repeal, revise or replace various facets of the law as it currently stands.
Having said all that, several provisions do kick in immediately that may affect community and hospital-based physicians:
- Children can no longer be denied coverage for pre-existing conditions
- Dependents up to age 26 can be covered under all individual and group health insurance policies
- Small businesses (no more than 25 employees and annual average wages of less than $50,000) that purchase health insurance for their employees will receive tax credits
- A temporary national high-risk pool will be established to provide health coverage to individuals with pre-existing medical conditions
- Health plans may no longer put lifetime limits on coverage and can only impose annual limits based on the amount HHS determines
- Insurers cannot cancel an individual's health insurance except in cases of fraud or nonpayment
- Health plans must provide 100 percent coverage, with no copayment, for most preventive services. This includes recommended immunizations and preventive care for infants, children, and adolescents.
Other components that will affect pediatric primary care physicians and specialists as the bill unfolds over the next 10 years:
- Higher Medicaid payments. In 2013-2014, Medicaid reimbursement for primary care services will be paid at 100 percent of the Medicare fee.
- Expanded Medicaid coverage. Beginning in 2014, all individuals under age 65 with or without children with adjusted family incomes below 133% of the federal poverty level may be covered under Medicaid. Children currently covered by the state Children's Health Insurance Program (CHIP) who fall within 100% and 133% of poverty will transition to Medicaid coverage. In order to reduce the fiscal impact experienced by states, the federal government will cover 100 percent of the additional cost; in following years, states will be responsible for an increasing percentage until by 2020 and beyond states cover 10 percent of the cost.
- New Medicaid demonstration projects. Beginning in 2012, one will pay bundled payments for episodes of care that include hospitalizations; another will allow pediatric medical providers organized as accountable care organizations to share in cost-savings.
- Fewer administrative hassles. Beginning in 2013, insurance plans must adopt a single set of rules for most administrative requirements, including eligibility verification and claims status and referral certification and authorization.
The greatest affect of health care reform, of course, will be thousands of newly covered children who will come to you for care. We know that there is a direct link between coverage and utilization, so primary care practices, in particular, will be extremely busy. This may be challenging if supply can't keep up with demand-or if doctors close their doors to new patients because of low reimbursement.
Preparation will be the key for all of us. It is important that you make sure your practices are running as efficiently as possible; new regulations standardizing administration requirements from insurance plans should help with that.
Physician practices might also consider expanding the use of physician extenders-nurse practitioners and physician assistants-to meet the additional patient load.
I will continue to bring periodic updates to this blog as health care reform rolls out. In the meantime, please feel free to post your questions here.
Click "Add Comment" below to contribute to the conversation.
Mark Lemoine has been the director of the government affairs department at Spectrum Health since 2004, and is a state and federal registered lobbyist. Lemoine has been involved in many leadership public policy roles for more than 18 years, holding positions with for-profit organizations, the Michigan Senate, and serving on the board of directors for a local nonprofit.