Kids and Health Care: Prevention and Diet
One reason that some health plans don't cover preventive medicine is that it often moves into areas like diet and hygiene -- which aren't traditional fields with which the insurance companies are familiar.
But managed care plans have been savvy about recognizing that a nutritionist on staff can provide enough good advice that at least a few young people learn about the many bad health effects of being overweight.
Preventive medicine or wellness programs may include meetings with a nutritionist. But, even if they don't, they are more likely to include doctors who are inclined to offer nutritional advice to their patients. This is important, because various studies from the AAP and other pediatric groups indicate that children and parents take nutritional advice from doctors -- when doctors offer it.
But, as one report noted in what passes for bureaucratic understatement: "Lack of reimbursement is a disincentive for physicians to develop prevention and treatment programs and presents a significant barrier to families seeking professional care."
This lack of reimbursement comes from indemnity insurance companies and -- ironically -- the CHIPs and other state-funded health plans available to children from poor families. Both types of plans have made some progress in matching the focus that managed care plans give to preventive care. But an explicit focus on preventive medicine for children would accomplish a number of useful goals in the fight against childhood obesity:
- The news would get out. Parents who don't already know about the high rates of obesity and its significant side-effects among American children would learn.
- The change from response to prevention would be especially important in regard to obesity because there's little long-term data that suggests response works.
- Genetic, environmental or combinations of risk factors that predispose certain kids to obesity would be measured.
- Early recognition of excessive weight gain relative to height would become routine in pediatric settings.
- Generally, families would be educated to recognize the impact they have on the development of lifelong habits of physical activity and nutritious eating.
- Dietary practices that encourage moderation and emphasize healthful choices rather than restrictive eating patterns would be reinforced.
Moving from these general goals to more specific measures, the AAP has made the following preventive health recommendations:
- Identify and track patients at risk by virtue of family history, birth weight, or socioeconomic, ethnic, cultural or environmental factors.
- Calculate and plot BMI once a year in all children and adolescents. Use change in BMI to identify rate of excessive weight gain relative to linear growth.
- Encourage, support and protect breast-feeding.
- Encourage parents to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods and whole grains, encouraging children's autonomy in self-regulation of food intake, setting appropriate limits on choices and modeling healthy food choices.
- Routinely promote physical activity, including unstructured play at home, in school, in childcare settings and throughout the community.
- Recommend limitation of television and video time to a maximum of two hours per day.
- Recognize and monitor changes in obesity-associated risk factors for adult chronic disease, such as hypertension, dyslipidemia, hyperinsulinemia, impaired glucose tolerance and symptoms of obstructive sleep apnea syndrome.
