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$6M grant to fund child obesity initiative

A Duke health economist has joined the ranks in the battle against childhood obesity.

The Centers for Disease Control and Prevention have awarded a $6.28 million grant to a group of researchers including Eric Finkelstein, associate research professor at the Duke Global Health Institute and deputy director at Duke-National University of Singapore Graduate Medical School, in an effort to reduce childhood obesity. Obesity—the condition of having a body mass index at or above the 95th percentile for children of the same sex and age—affects approximately 17 percent of children between the ages of 2-years-old and 9-years, according to the CDC. This rate has nearly tripled since 1980.

The National Institutes of Health and the Institute of Medicine have called for a systems-oriented approach, which addresses how to structure health care on a community-wide level. The study will work to connect the functions of families, health care providers, schools and other organizations to educate people about obesity. This strategy is necessary because other national efforts to address childhood obesity have failed at halting the epidemic, Finkelstein said. His role in the study will involve analyzing how people make decisions and how public policy can affect that process, he added.

“Obesity is a great area to study because efforts to drive down obesity rates will require people to make increasingly difficult choices about diet and exercise in a world where that is often no longer required,” Finkelstein wrote in an email Monday.

Finkelstein will collaborate with principal investigators Deanna Hoelscher, director of the Michael & Susan Dell Center for Healthy Living at the University of Texas School of Public Health, and Nancy Butte, professor of pediatrics at the Baylor College of Medicine. As the economist on the team, Finkelstein will help structure the economic incentives for participants and lead cost-effectiveness analysis.

“Child obesity is a problem bigger than any of us can tackle by ourselves. We need to work together,” Hoelscher said in a news release Oct. 24.

The collaborators hypothesize that among low-income, ethnically diverse overweight and obese children from 2-to 12-years-old, the new approach with secondary, medically specialized prevention programs will help reduce weight problems in comparison to primary prevention alone, Finkelstein noted. In order to evaluate this prediction, assessments will be conducted in disadvantaged neighborhoods of Austin and Houston, Texas to inform which intervention strategies are used and provide a sustainable program structure.

There are three specific aims of the study, Finkelstein said. The first is to implement and evaluate a primary prevention obesity program in low-income, ethnically diverse areas of Austin and Houston. This step will utilize baseline and two-year follow-up data on the prevalence of childhood risk factors and the availability of health care for parents, children and the community.

The second aim is to implement and evaluate how effective a systems approach is at reducing obesity by using a 12-month family-based secondary prevention program along with the primary care.

The third goal is to measure how cost-effective the 12-month program is compared to just the primary care.

“If this research trial is proven efficacious and cost-effective, the demonstration project could be disseminated widely to address obesity among underserved, at-risk children,” Finkelstein said. “Program sustainability will be ensured through active involvement of community partners within health care, childcare, schools and community sectors.”

Definitive conclusions about the effectiveness of the model will likely be made in about three years, Finkelstein added. If the primary and secondary strategies prove effective at reducing obesity, the United Kingdom-based Mind Exercise Nutrition Do it! Programme will deliver the intervention on a broad scale, work to publicize it and finance the expansion.

Successful findings would have very positive effects on the lives of the children at risk for obesity. Obesity predisposes children to serious health risks including Type II diabetes, cardiovascular disease, atherosclerosis, cancer, sleep apnea, chronic respiratory, disease and orthopedic problems, said Dr. Michael Freemark, Robert and Veronica Atkins professor of pediatrics and division chief of pediatric endocrinology and diabetes.

“Anything that has such substantial chunks of the population as obesity, has large economic and financial implications,” Freemark said. “We have a right to be concerned, seriously concerned, about the implications and presence of obesity in children. It’s likely to have poor ramifications for medical costs and practice and social and economic considerations of the [U.S.] and world economy. Health care costs are continuing to rise dramatically and obesity and diabetes play major roles in the escalation of those costs.”

The Pediatric Obesity Care Model is the first of its kind, Butte said in a news release Sept. 29, noting that if successful, the model could become a new component of integrated medicine and community health practices.

Freemark has a more cautious attitude towards the community-based model of this research but said he is also in favor of aggressive action against obesity.

“This approach is probably a good one.... It’s going to require policy changes [and] the involvement of everyone in the community,” he said. “It should succeed, but so far, success of community wide projects has been limited.... A fair number of different approaches would have to be employed. None are going to be successful alone.”


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