Healthy Weight Teams Embracing Integration Across Sectors

February 3, 2013
By Julie Eisen

“There’s so much rich work going on in communities across these teams,” said Improvement Advisor Dr. Kathy Reims, who is coaching the 10 teams involved in Phase One of the Healthy Weight Learning Collaborative. “We set out to work in an integrated fashion across primary care, public health, and community. All the teams have really embraced that and are working very, very hard in each one of those areas.”

The Healthy Weight Learning Collaborative is a quality improvement initiative to promote healthy weight and health equity in communities across the United States. Phase One of the initiative, which began in September 2011, has included ten regionally-based teams, each composed of representatives from primary care, public health, and community-based organizations.

While team members hail from many different types of organizations and bring a variety of experiences and expertise, they share one thing in common: the goal of working across sectors to identify, test, and evaluate evidence-based program and policy changes to prevent and treat obesity and overweight in their communities.

Primary Care
“The primary care sector has done a lot of work in redesigning their systems, assessing people for current weight status, and also in figuring out ways to have respectful conversations with the patients that they serve,” said Reims. At the heart of this work is a customizable Healthy Weight Plan that helps primary care physicians assess individual patient status and make recommendations on healthy behaviors.

In Montana, the Healthy By Design Quality Collaborative has received feedback on their Healthy Weight Plan template from the four primary care providers serving as pilot sites. Based on this feedback, the plan is being reformatted, with more resources added. The pilot sites will review these changes before the template is distributed for wider use.

In addition, the teams are testing different ways to measure the impact that they’re having in their primary care sites. For example, the Greater Rochester Obesity Collaborative in New York has been testing a variety of tools to find the best way to collect information from their target population and get feedback about the effectiveness of their efforts.

Public Health
Within the public health component of the Healthy Weight Learning Collaborative, the teams are primarily focusing on promotional activities around their healthy weight messaging. “They are testing ways to make this work from a community-centric, population-based approach,” said Reims.

Most of the teams are basing their messaging on the 5-2-1-0 message developed by the Let’s Go! program in Maine (5-2-1-0 stands for 5 or more fruits and vegetables, 2 hours or less of recreational screen time, 1 hour or more of physical activity, and 0 sugary drinks). However, each of the teams has succeeded in customizing the message for their community. For instance, in Massachusetts, the Boston Area Collaborative for Health’s message is called "STEPS to Health” (STEPS stands for Sugar Smarts, TV and media time limits, Exercise/Physical Activity, Plan a Plate for a balanced diet including lots of fruits and vegetables, and Sleep sufficiently.)

“The teams are using these messages to leverage, engage, and convene all of the multiple stakeholders in the community. That’s where we’re really starting to see traction,” said Reims.

Community Changes
As for the community sector, the project is benefiting from the participation of a very diverse set of representatives across all the teams—from a mayor, to members of the Parks and Recreation Department, to local businesses, to farmers and grocery stores. According to Dr. Reims, there has been wonderful engagement in the community sector because of the many different perspectives and skills.

A great example of collaborative engagement with the community comes from the St. Charles Health Council in Virginia, which has partnered with a staff nurse to promote physical activity to students by teaching Zumba classes. As a result, three schools in the area have requested Zumba classes for children during physical education classes.

And the ARcare team in Arkansas partnered with a principal at one of the local schools and now has the opportunity to work with the teachers in promoting the 5-2-1-0 message and other aspects of the project.

Pulling It All Together
“But perhaps the most profound and compelling work,” said Reims, “is how the teams have been able to integrate this work across the sectors. That’s what’s most exciting—to see the new conversations and relationships, and the way that the teams are thinking about how to put all this together.”

While there are undoubtedly many different reasons for the progress these teams have experienced, there is one factor that stands out to the project faculty and staff. “They’re really using the quality improvement methodology we’ve set forth, and they’re using it well,” said Reims.

“We still have a lot more to learn from these teams,” she said.