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Podcast Transcript

Teaming Up to Help Communities Promote Healthy Weight

Charles J. Homer, MD, MPH, President and CEO, National Initiative for Children’s Healthcare Quality

Kyu Rhee, MD, MPP, FAAP, FACP, Chief Public Health Officer, Health Resources and Services Administration, U.S. Department of Health and Human Services

January 20, 2011

Open with short podcast series music.

RHEE:

Hello, my name is Kyu Rhee. I’m the Chief Public Health Officer at the Health Resources and Services Administration and also a practicing internist and pediatrician. I’m very happy to be here today to talk about the Healthy Weight Collaborative. This is an initiative that is aligned with the first lady’s “Let’s Move” initiative, and HHS’s (Health and Human Services’) priority in looking at ways in which we can promote healthy weight. The collaborative is funding a Prevention Center for Healthy Weight. We’re very happy to have Dr. Charlie Homer from the National Initiative for Children’s Healthcare Quality to talk more about the collaborative and this initiative. Dr. Homer?

HOMER:

Thank you very much, Dr. Rhee. It’s a pleasure to speak with you, and we are just so excited about launching the prevention center and conducting the Healthy Weight Collaborative. This program is going to extend over approximately the next 15 months, and we’ll be working with transectorial teams from over 50 communities across the country. We’re going to try help each of these teams to make their communities more healthy places to promote healthy weight for all of their citizens and members of the community. We’ll be doing that by bridging the worlds of the health care community and the primary care community, with both the public health and the broader parts of the community such as the school departments, transportation, agriculture, so that we can really create healthier places for children, youth, and families to address this obesity epidemic.

We’re trying to identify what some of the most promising practices are, and some cutting-edge ideas. I wonder if you could share with me some of your thoughts about some of the approaches that you’ve thought of that we might be able to incorporate and help these communities adopt.

RHEE:

Thank you, Dr. Homer. The importance of what I like to refer to as the 3 T’s of innovation: trans-disciplinary approaches, translational thinking and approaches, as well as transformational disruptive innovations.

So, being transdisciplinary really requires us to think transectorially, as you’ve mentioned, recognizing the importance of primary care, but also seeing the importance of going beyond the four walls of your exam room, out into the community, and thinking more broadly about what we can do to address population health.

Going into translational, we know that science often takes 17 years to translate into real-world practice. And part of being innovative, you need to translate that science much quicker, because 17 years is too long to wait. So, how do we really get these evidence-based interventions and get that disseminated more broadly in use, and translate that science into real-world practice?

Then the last item is being really transformational, and not only just thinking out of the box, but getting rid of the box. We have to be creative, whether it’s mobile health — using texting interventions or thinking about ways in which people are using their social networks to promote healthy behaviors — or whether it’s using community health workers. We have to really try to be transformational in our thinking. So those are the 3 Ts that I think of.

So Dr. Homer, could you describe the kinds of innovations that you think look promising?

HOMER:

There have been a lot of excellent ideas about what works, what’s starting to work to address this epidemic. Some of those have been identified by some of the important national task forces. One is the U.S (clinical) Preventive Services Task Force, which has come up with recommendations for what happens within the clinical office practice, including screening for overweight and obesity, including making referrals and recommendations — referrals, for example, to high-intensity services for youth, and providing appropriate counseling for adults.

Similarly, the CDC-supported Community Preventive Services Task Force has made a series of recommendations for what needs to take place in communities, and what kinds of programs have been successful. Those are great places for us to start, and that’s typically where we would look to find the most solidly evidence-based recommendations.

When we think of other promising interventions, what I like to do is combine some of those recommendations for what needs to happen with mechanisms for how do you ensure that those happen every time you encounter a patient (if it’s in a clinic) or every time you encounter a student. And to me that combines with some system thinking — thinking about how do you actually design the systems in which you work. So that’s something where I’ve seen a lot of innovation, certainly within sectors, and what will be very exciting in this program is the opportunity to apply that kind of system-based thinking across sectors.

One thing that I’m very excited about, building on your transdisciplinary concept, is the idea of taking a concept that applies in one area and then moving it somewhere else. So one of the most promising areas about counseling for obesity has been the application of something called motivational interviewing, which has worked very well and was developed for counseling about things like substance abuse. And now we’re finding this extremely powerful in motivating other kinds of behavioral changes.

When we reach out to broad communities, like the faith-based community or other communities, we find lots of new ideas come up. So one very popular idea people talk about is this concept of a walking school bus. How do you build regular physical activity into people’s daily lives? If kids need to get to school, instead of putting them on a bus and driving them the whole way, you can have a safely monitored group of people walking together.

So with this project, we’re intending to bring together teams from a community that represent the multiple sectors in a community that are involved in promoting and producing health. So that would include teams from health care delivery organizations — primary care sites in particular — but also include public health departments, also include schools, include after-school programs, YMCAs. But we know that each community is different, and that each community is likely to invent their own approaches, some of which may be helpful for other communities to learn about.

So we’re very much hoping that through the course of this project, the teams that are participating — as well as other communities or people from particular sectors in their communities that have good ideas that they want to be tried out, or to be applied elsewhere — will be contributing those, either through the process with the Innovations Exchange, or more directly to a web portal that we’ll be establishing for the program.

NARRATOR:

Please check out the Innovations Exchange Web site for profiles about innovations on obesity-related issues. As part of the Healthy Weight Innovations Exchange Partnership, HRSA and AHRQ will be developing more profiles about innovations that contribute to the vital objective of reducing obesity and overweight.