Ohio anti-obesity plan would reward healthy behavior, rely on farmers markets

COLUMBUS, Ohio — Ohio’s five-year plan to fight obesity would put locally made foods in vending machines, nearly quadruple the number of farmers’ markets that accept food stamps, expand breastfeeding-friendly policies in the workplace, and increase medical research on obesity.

By the end of the five years, the state would want insurance companies and hospitals to offer incentives to “encourage patients to achieve a healthy weight and lifestyle.”

The details are included in a rough draft of the Ohio Obesity Prevention Plan (pdf) released earlier this week on the state’s Healthy Ohio web site. The plan aims at reversing obesity growth rates by 2014. Nearly 27 percent of the state’s adults are obese as are 12.4 percent of high school students, according to The Trust for America’s Health.

The Ohio Department of Health has opened a public comment period on the plan that ends Feb. 20. Afterward, a final recommendation will be sent to Gov. Ted Strickland.

“Obesity is an extremely complex interplay of the genetics of the person and the environment,” said Dr. Robert Murray, director for the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus.

“The thing I was most struck by is the Ohio Department of Health is saying, ‘If we are going to address this, how do we get our arms around this… and how do we look at all the responsibilities and roles (in obesity) and how to we make this work?’ ”

The draft offers more ideas than answers — at least for now. State officials said they don’t know how much the entire campaign would cost or whether, for example, they would use state mandates, financial incentives or a bully puplit to get employers to alter workplace policies, such as those on breastfeeding, which helps cuts the chances of childhood obesity.

Would doing more obesity research in the state mean supporting studies that highlight the best approaches to keeping children slim? Or would it mean diverting research grants to companies like Athersys, which is developing a promising anti-obesity drug?

“Probably more of the former,” said Cynthia Burnell, director of Healthy Ohio. “The committee’s thinking is that we examine a healthier lifestyle-kind of approach rather than investing in pharma research.

“But that’s why we have public comment,” she said.

The plan proposes to reverse rising obesity rates by improving opportunities for physical activity and access to healthy foods, limiting access to unhealthy food, and better coordinating policies and resources to reduce obesity. A large portion of the campaign centers around educating young people and targeting childhood obesity.

In 2009, the plan would build databases, Web sites and marketing campaigns to promote and monitor health. It also would try to consolidate wellness and weight-loss efforts already run by public agencies. It also plans to use state funds this summer to build more areas for physical activities around schools.

The plan branches out in 2010 and beyond. It includes:

• Support public works projects to build better sidewalks and bike paths. By the end of 2012, the number of children who walk or bike to school in Ohio’s Safe Routes to Schools communities could increase by 5 percent.
• By the end of 2014, create a network that delivers food from Ohio farmers’ markets directly to schools.
• Identify “food deserts” — geographic areas where it’s difficult to get healthy food — and by 2015, cut these areas by 10 percent.
• By the end of 2011, develop a program that reduces obesity among Medicaid users and improves the state’s obesity-related pediatric practices.

Health officials are eager for more specifics and state funding. “While extremely pleased with the call for physical education in school, we wish the scope of this education (time spent in activity, number of days required, etc.) were better defined,” Iris J. Meltzer, administrative director of adolescent health for Akron Children’s Hospital, wrote in an e-mail.

Dr. Ellen Rome, section head of adolescent medicine at the Cleveland Clinic, said many of the efforts outlined in the plan are underway to the Clinic and other Ohio children’s hospitals. Rome particularly praised ideas about increasing walking and biking for schoolchildren, eliminating the food deserts and consolidating existing efforts.

“It doesn’t create the infrastructure because it’s already started,” Rome said. “But this would help sustain it.

“It’s our hope the state will put the resources behind these efforts,” she added. “We are in a bad economy. I don’t see anything set in stone.”

The report also does not elaborate on how insurers and providers would install incentives for healthier living. Though concept of adding incentives to Medicare, private insurance policies and hospitals to promote healthier living is increasingly popular.

Many private-sector companies already use such policies. On the public side, Kentucky, Idaho and West Viriginia have already experimented with such plans, and federal officials including U.S. Sen. Ron Wyden have encouraged expanding incentives policies.

Consumer health advocates, including Families USA, warn that incentives could make it harder for some patients to see a doctor (pdf) by increasing the cost of office visits or encouraging patients to lie about their habits.

Murray said any policy should avoid punishing people for simply being overweight. “Instead, adopt healthy lifestyle rewards,” Murray said. “You can be overweight and physically fit…. What you want to do is lead a healthy lifestyle in the context of gender and ethnicity.”

[Front display photo courtesy of Flickr user Malias]