Learning to be lean

As one of the many outgrowths of the sweeping federal health care law, health insurers and employers must now pay the cost of screening children for obesityand providing them with appropriate counseling.

Stew Milne for The New York Times

Ryan May weighing in Elijah Byers, 8, at a weight loss program in Rhode Island.

Stew Milne for The New York Times

Ryan May meeting with overweight children at the YMCA of Greater Providence.

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With about one in three children in the United States obese or overweight, according to government statistics, the need for such programs is clear. But, experts say, creating them will be challenging. Other than intensive hospital-based programs, few proven models exist for helping children and adolescents achieve and maintain a healthier weight, and researchers do not even fully understand the factors that contributed to the rapid rise in childhood obesity in recent years. “If this were easy, if there were clear outcomes for success, we would be investing in these,” said Dr. Samuel R. Nussbaum, the chief medical officer for WellPoint, one of the nation’s largest health insurers.

While there are many community efforts aimed at getting every child to eat better and exercise more, including Michelle Obama’s “Let’s Move” initiative, there is also growing demand for programs that help children who are already seriously overweight. WellPoint and the UnitedHealth Group, another large insurer, are experimenting with new approaches, and even Weight Watchers says it is working to develop a program for children and teenagers. Drug companies and medical device makers are also testing some products on children.

Adults have a difficult enough time losing weight, and the issues are even more complicated with children and teenagers, experts say. Children are still growing, and the goal of any program may be to help them grow into a healthier weight rather than to actually lose pounds. Experts also say that to be successful, programs need to focus on the family as a whole, changing what everybody eats and how much time they are all active, not sitting in front of a computer screen or television.

UnitedHealth’s pilot program, aimed at these family dynamics, was conducted in partnership with the YMCA of the USA and the YMCA of Greater Providence, R.I. The sessions at the Y, with young children or teenagers talking about their struggles with food and exercise, are intended to be a friendlier, more cost-effective alternative to hospital programs.

Accompanied by a parent, the children meet for 16 hourlong sessions, initially once a week. Led by a coordinator who has been trained at a Y or other community setting, the children and parents learn about what foods they should favor, why children may be overeating and how to balance what they eat with how active they are.

In Rhode Island, parents like Dana Morel said the program was appealing because there were few other options. “There really wasn’t anything like this,” said Ms. Morel, who enrolled her son, Ryan, after hearing about it from her local Y. “That’s why we jumped on this.”

Ryan, now 11, said he was initially reluctant to go to the meetings but was won over by the woman leading the group and the promise of $150 in gift cards if he filled out the paperwork (The use of gift cards was limited to the study.)

Ryan, who weighed 122 pounds, lost 30 of them as he learned to make better choices about what he ate and to recognize that he sometimes ate because he was bored. He learned to limit his portions and substitute turkey burgers for cheeseburgers.

Already active in sports like soccer, the leaner Ryan said he has become a better player. “I’m faster,” he said. “I don’t lose my breath as quickly. I can run.”

The early results of UnitedHealth’s efforts are promising, according to the insurer, which said that 84 percent of the 155 children and teenagers completed the program and had an average 3.5 percent reduction in weight after six months. Parents also lost weight, according to UnitedHealth. The insurer says it is expanding the program, even as it continues to study its longer-term impact.

Raytheon, a military contractor, started offering the sessions to its employees in Massachusetts and Rhode Island as part of a pilot program. “We are always seeking out innovative ways to help our employees and their families live healthy lifestyles,” Keith J. Peden, a Raytheon executive, said in a statement.

UnitedHealth is now working with Texas and Louisiana to offer a similar program this year for children enrolled in Medicaid under the insurer’s Medicaid plans.

“There’s not a lot of programs, especially programs that children are interested in participating in,” said Dr. Rodney Wise, the medical director for Louisiana’s Medicaid program. The state, which suffers from one of the country’s highest rates of obesity, is asking all the health plans serving Medicaid to address the problem.


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