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Stephanie Rost MS, RD, Corporate Program Development Director, Weight Watchers, Int’l, New York, NY George Askew MD, FAAP, Senior Policy Advisor for Early Childhood Health and Development, Administration for Children and Families, Washington, DC Susan Swider PhD, APHN-BC, Professor, Rush University College of Nursing, Chicago, IL Weight Watchers International, Inc. -A science-based lifestyle modification approach focused on health promotion Stephanie Rost, MS, RD, Director of Corporate Program Development Friday, October 14, 2011 4 About Us • Who We Are – Leading global provider of weight management services for nearly 50 years – Available in 25 countries • Our Reach – U.S. – Annually more than 1.7 million enrollments in Weight Watchers meetings and 1 million signups for WeightWatchers.com – 25,000 meetings each week held in convenient times and locations (~ 5000 in workplace) • 75% of our members live with a 12 minute drive to a meeting Weight Watchers Method • Developed by healthcare professionals – • Delivered by role models in a supportive environment – • A lifestyle modification program based on science that includes education, behavior change and group support All meeting staff have consistently lost and maintained their weight on the Weight Watchers program This method enables science to be translated and applied in a way that real people can understand and follow in a sustainable way. How to Follow Weight Watchers •Monthly Pass: •Unlimited meetings •Etools •$39.95/month •Most popular option Monthly Pass: More Engagement, More Weight Loss • People who attended meetings + eTools lost 50% more weight than those who attended meetings alone* 14 Weight loss (lbs) • Strong correlation between meeting attendance and weightloss success 16 12 10 8 6 4 2 0 24 weeks *Nguyen V et al. Obesity 15(9) suppl. A221, 2007. Mtgs Mtgs + Web Weight Watchers Meetings • Weight Watchers staff give a private and confidential weigh-in prior to the meeting start • Each meeting is a discussion led by a Leader, with new topics each week (topics are consistent in every location) • Topics cover everything from holiday eating and struggles to family meal ideas, with lots of tips and suggestions • Leaders are trained in the program and to pass on their expertise and unique personal experiences as Lifetime Members of Weight Watchers Online • Tracking tools, robust content on weight/lifestyle topics, recipe builder, community • ~1 million subscribers • Mobile options (iPhone/iPad/Android) • > 1.5MM downloads of iPhone App • WW Kitchen Confidential Ipad App • Support for other mobile platforms The Four Pillars of the Weight Watchers Approach Diet Activity Cognitive Skills Social Support Uses formula based on macronutrients, net calories and satiety to calculate PointsPlus value of a food Fruit and most vegetables assigned 0 PointPlus value “Power Food” designation rates foods based on health and satiety Scientific Heritage • Strong commitment to evaluating efficacy of the Weight Watchers methodology •Established body of evidence • 65 original scientific publication todate and growing •Located in the Weight Watchers Scientific Compendium Online • Scientific Advisory Board composed of world-renowned obesity experts Primary Care Referral to a Commercial Provider for Weight Loss Treatment, relative to standard care: An international randomized controlled trial. Susan A Jebb, Amy L Ahern, Ashley D Olson, Louise A Aston, Christina Holzapfel, Julia Stoll, Ulrike Amann-Gassner, Annie E Simpson, Nicholas R Fuller, Suzanne Pearson, Namson S Lau, Adrian P Mander, Hans Hauner, Ian D Caterson MRC Human Nutrition Research, Cambridge, UK (published in The Lancet, September 7th, 2011) 14 Study objectives Primary objective • To examine the differences in weight loss at 12 months between general practitioner referral (GP) to Weight Watchers (WW) program and standard management in primary care (as informed by national guidelines) across 3 countries. • N = 772 participants (n = 377 WW, n = 395 SC) Secondary objectives • To investigate the number of subjects losing 5% or 10% of baseline weight in each group. • To investigate changes in indicators of metabolic risk – including waist circumference, body composition, blood pressure, blood glucose, lipids, etc. 15 Results • In all analyses, participants referred to WW lost more than twice as much weight as people receiving standard care over 12 months • Weight loss over 1 year with WW was an average of 7 kg (15.4 lbs) – This is considerably less than the 3 kg (6.6 lbs) loss among standard care • Among WW completers, 60% of participants lost >5% and 32% lost >10% of baseline weight – Among Standard Care completers, 25% lost >5% and about 9% lost >10% of baseline weight • Odds ratios of WW group achieving at least 5% or 10% weight loss at 12 months: – All subjects: 3.0; 3.2 – Completers: 2.9; 3.5 16 Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS Amy L Ahern, Ashley D Olson, Louise A Aston, Susan A Jebb. BMC Public Health 2011, 11:434. Identify and prescribe a set of solutions that reverse or prevent the progression of weight of gain Progression of Weight Gain Requires a Portfolio of Solutions Variety of options needed to match the diverse needs of individuals with effective solutions Morbid Obese Obese Surgeries (e.g., banding, gastric sleeve) Medical Devices (e.g., VBLOC) Medications (e.g., sibutramine, phentermine) Overweight Lifestyle Modification • Structured eating plan Healthy Weight • Regular physical activity • Cognitive skills • Support Research in Early Head Start GEORGE L. ASKEW, MD, FAAP OFFICE OF THE ASSISTANT SECRETARY ADMINISTRATION FOR CHILDREN AND FAMILIES U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES AMERICAN ASSOCIATION OF NURSING 3 8 TH A N N U A L M E E T I N G A N D C O N F E R E N C E OCTOBER 14, 2011 What I Will Cover Today Brief Overview of Administration for Children and Families Brief Overview of Early Head Start Review of Research in Early Head Start (BABY FACES) Questions and Answers Administration for Children and Families What is Early Head Start? Head Start Early Head Start Established 1995 Serves children birth to three: 1008 programs; over 133,000 children Promotes healthy prenatal outcomes, enhances the development of infants and toddlers, and promotes healthy family functioning. 4 Cornerstones: Child Development, Family Development, Community Building and Staff Development 3 other areas of importance: Administrative Management, Continuous Improvement and Children with Disabilities Service Delivery: PIR & Baby FACES Staff Characteristics Teachers HV 6 22 39 33 2 20 27 51 64 55 8 59 4 6 Highest level of education: High school or less Some college Associate’s Bachelor’s or higher Field of study early childhood or child development CDA Elevated depressive symptoms Linguistic and Ethnic Diversity What Do We Know About Health of EHS Children? Children Are Healthy at Birth and Age 1 Low rates of premature birth and low birth weight (about 10 percent) 63 percent were breastfed (average 4 months) 96 percent have insurance coverage 92 percent up-to-date immunizations 74 percent had well-child checkups Poor Feeding Practices Start Early Percentage Parent Reported Feeding Practices at Age 1 Some Incidence of Positive Feeding Practices Percentage Parent Reported Feeding Practices at Age 1 Children’s BMI Similar to Other Low Income Samples About 1/3 are overweight or obese at age 2 – 16 percent are overweight (85-94th percentile) – 17 percent are obese (95th percentile or higher) Just 6 percent of parents report a medical professional said child is overweight Rates of overweight and obesity not predicted by feeding practices or other characteristics (including race/ethnicity) Programmatic Initiatives Office of Head Start is piloting obesity prevention programs: – Head Start: I Am Moving I Am Learning – Early Head Start: Little Voices for Healthy Choices Overall Impacts for Children: Age 3 Higher immunization rate Fewer emergency room visits for accidents and injuries Cognitive development (higher Bayley scores & fewer in low-functioning group*) Larger receptive vocabularies Lower levels of aggressive behavior Greater sustained attention with objects, engagement of parent, and less negativity Overall Impacts for Parents: Age 3 More positive (and less negative) parenting observed in parent-child play: both mothers and fathers Higher HOME scores, more stimulating home environments, support for learning More daily reading Less spanking: both mother and father report More hours in education and job training Impact on Breastfeeding For those women who enrolled during pregnancy: 44% of EHS moms 33% of the control group Questions ?s Promoting happy, healthy and successful children, strong families and supportive communities The National Prevention Strategy Disease Prevention and Health Promotion for Populations Susan M. Swider, PhD, APHN-BC, Rush University [email protected] Health Promotion Initiatives Panel, Health Promotion Across the Lifespan: Focus on Evidence October 14, 2011 National Prevention Strategy 41 The Affordable Care Act In Addition to Coverage, Quality, and Cost… Unique Opportunities for Prevention Global Health Indicators (OECD, 2008) % GDP Spent on Health 18 16 14 12 10 8 6 4 2 0 US Germany Japan % GDP UK Canada Global Health Indicators (WHO, 2006) Life Expectancy 84 82 80 78 Years 76 74 72 US Germany Japan UK Canada Global Health Indicators (CIA World Factbook, 2009) Infant mortality (# deaths before age 1/1,000 live births) 10 8 6 # deaths 4 2 0 US Germany Japan UK Canada US Health Outcomes • United States is a global leader in medical technology, treatment, and research, BUT • 47 million Americans lack health insurance • Health care costs at 14-16% GDP • Significant disparities in health access and outcomes across race and SES Social determinants of health Economic and social conditions under which people live which determine their health. • • • • • Race/ethnicity Income Education Housing Civil unrest Proportion of Early Deaths Preventable by Treatment Type 20% 10% Medical Treatment Public Health/Prevention Genetic (not preventable) 70% Contributions of Prevention and Medical Treatment to the 30 years of Increased Life Expectancy Achieved Since 1900 17% Medical care Prevention 83% Focus of U. S. Health Expenditures 4% Medical Treatment Public Health 96% National Prevention Council Bureau of Indian Affairs Department of Labor Corporation for National and Community Service Department of Transportation Department of Agriculture Department of Veterans Affairs Department of Defense Environmental Protection Agency Department of Education Federal Trade Commission Department of Health and Human Services Office of Management and Budget Department of Homeland Security Office of National Drug Control Policy Department of Housing and Urban Development White House Domestic Policy Council Department of Justice 51 Advisory Group • 17 non-federal members • Statutory Role: – Develop policy and program recommendations – Advise National Prevention Council on prevention and health promotion practices 52 National Prevention Strategy • Extensive stakeholder and public input • Aligns and focuses prevention and health promotion efforts with existing evidence base • Supports national plans 53 Vision Working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness. 54 National Prevention Strategy 55 Healthy and Safe Community Environments • Clean air and water • Affordable and secure housing • Sustainable and economically vital neighborhoods • Make healthy choices easy and affordable 56 Clinical and Community Preventive Services • Evidence-based preventive services are effective • Preventive services can be delivered in communities • Preventive services can be reinforced by community-based prevention, policies, and programs • Community programs can promote the use of clinical preventive service (e.g., transportation, child care, patient navigation issues) 57 Empowered People • People are empowered when they have the knowledge, resources ability, and motivation to identify and make healthy choices • When people are empowered, they are able to take an active role in improving their health, supporting their families and friends in making healthy choices, and leading community change 58 Elimination of Health Disparities • Health outcomes vary widely based on race, ethnicity, socio-economic status, and other social factors • Disparities are often linked to social, economic or environmental disadvantage • Health disparities are not intractable and can be reduced or eliminated with focused commitment and effort 59 Priorities • Tobacco Free Living • Preventing Drug Abuse and Excessive Alcohol Use • Healthy Eating • Active Living • Mental and Emotional Well-being • Reproductive and Sexual Health • Injury and Violence Free Living Five Causes Account For 66% of All Deaths Heart Disease All Other Causes 34% 5% 5% Cancer 27% Chronic Lower Respiratory Disease 23% Stroke 6% Unintentional Injuries Source: National Vital Statistics Report, CDC, 2008 60 Recommendations (Example) Active Living • Encourage community design and development that supports physical activity. • Promote and strengthen school and early learning policies and programs that increase physical activity. • Facilitate access to safe, accessible, and affordable places for physical activity. • Support workplace policies and programs that increase physical activity. • Assess physical activity levels and provide education, counseling, and referrals. 61 Actions (Example) Federal Government will…. • Promote the development of transportation options and systems that encourage active transportation and accommodate diverse needs. • Support adoption of active living principles in community design, such as mixed land use, compact design, and inclusion of safe and accessible parks and green space. • Support coordinated, comprehensive, and multicomponent programs and policies to encourage physical activity and physical education, especially in schools and early learning centers. 62 Partners Can…. (Example) States, Tribal, Local, and Territorial Governments • Support schools and early learning centers in meeting physical activity guidelines. Businesses and Employers • Adopt policies and programs that promote walking, bicycling, and use of public transportation. Health Care Systems, Insurers, and Clinicians • Conduct physical activity assessments, provide counseling, and refer patients to allied health care or health and fitness professionals. Individuals and Families • Engage in at least 150 minutes of moderate-intensity activity each week (adults) or at least one hour of activity each day (children). 63 NPS Implementation Resources: Indicators/Key Documents 64 NPS Implementation Resources: Evidence by Recommendation 65 NPS Implementation Resources: Key Indicators 66 Optimal Implementation Communication Alignment Network & Capacity Building Partner Engagement Analysis and Research Evaluation and Accountability 67 What’s Next • Execute and coordinate NPS actions across Council agencies • Encourage partners to create and execute their own NPS action plans • Monitor and track progress • Share successes! 68 Implications for Nursing • Research into effective disease prevention and health promotion strategies – individual and population level • Educate students and nurses on effective health promotion and disease prevention strategies • Practice disease prevention and health promotion – New partnerships • Civic and policy activism in reforming health care For more information go to: www.healthcare.gov/nationalpreventioncouncil Contact the National Prevention Council at: [email protected] 70 Academy Open Forum