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When young, obese California Medicaid beneficiaries enroll in Health Net’s weight management program, a health coach involves the entire family in the program, called Fit Families for Life.
“We encourage the entire family to take on healthier habits. Everybody benefits from this program, not just those who need to lose weight,” says Dennis Carrillo, MPH, health promotion specialist with Health Net’s Health Education Department.
The telephonic coaching program focuses on children and adolescents, ages 6 to 20, who have a body mass index at the 95th percentile, which classifies them as obese, Carrillo says. The Los Angeles-based managed care plan also offers a home edition of the Fit Families for Life program for members and offers weight-management classes to community-based organizations.
The coaching program is new, and no formal outcomes information is available. However, some participants have reported losing four or five pounds by the end of the program, Carrillo says.
“Because they are children, we want them to maintain their weight as they grow,” he says. Some have lost 10 to 14 pounds, he adds. “It depends on where the family is in being ready to make changes in their lifestyles,” he says.
The telephonic coaching program is open only to obese young people referred by their physicians, but the home edition of the program is open to any member who requests the materials.
Participants in all Fit Families for Life programs use a workbook to guide them through the five sessions on adopting a healthier lifestyle. They also receive a cookbook, an exercise band, and a DVD.
“The DVD goes into detail on how to make healthier meals, how to reduce portions, and include fruit and vegetables in the diet. It also includes 10-minute exercise sessions, including floor exercises, standing exercises, chair exercises, and how to use the stretch band for strength training,” Carrillo says.
The health coaches are registered nurses with backgrounds and training in nutrition. They are supported by registered dieticians.
Providers are encouraged to refer the highest-risk members to the coaching program and to include additional information on comorbidities and other issues that need to be addressed.
Once members are identified, the health coach reaches out to the family, informs them about the program, and enrolls them. In the majority of cases, the coaches talk to the mother, who makes the decisions about the types of food included in meals. If the member is older, the coach does direct coaching with the teen.
The program covers nutrition, making healthy choices, the importance of exercise, and the consequences of obesity.
The coaches have five telephonic sessions with the families, often over a period of months. During the initial call, the coach assesses the participants’ level of understanding on topics such as reading labels and healthy meals. The coach conducts another assessment later in the program to determine how much progress has been made.
“We made the program telephonic to remove as many barriers as possible. The Medicaid population is hard to reach. We try to catch them at opportune moments and engage them in the program,” Carrillo says.
The coach tailors the program to the family’s needs. “When they talk to older kids, the coaches discuss how to recognize what triggers negative behavior. For instance, when someone is feeling depressed or unhappy, they may find comfort in food. When there are special occasions such as holidays, people may use that as an excuse to overeat. The coaches make the teens aware of these possibilities and go over a variety of ways to avoid them,” he says.
The health plan offers participants $10 on a reloadable gift card for each successful coaching call. “They can earn up to $50 on the gift card, but we do limit what they can buy. They can’t buy alcohol or tobacco, and we hope they will use it for healthy items at selected retailers,” he says.
Participants in the coaching program are offered a text messaging option. If they consent, the health plan sends them weekly messages to support their goals, such as reminders to read the food labels and encouragement to keep exercising.
Some of the participants in the home edition of the program are referred by their physicians, but many self-refer, Carrillo says. The families watch the DVD and follow along in the workbook.
Among the 1,000+ Medicaid members who finished the home-based, family edition of the program in 2013, 72% of respondents said they were reading food labels more often, 89% said they eat more fruits and vegetables, and 78% said they maintained or increased their level of exercise.
Health Net offers Fit Families for Life workshops or a series of classes in English and Spanish to community-based organizations in 12 counties where it provides Medi-Cal — California’s Medicaid program — benefits as long as they can provide a space. The classes are free and include all of the materials.