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Working Together to Turn the Tide on Childhood Obesity
- 1. Working Together To TURN THE TIDE On Childhood Obesity A project of @Zamzee
- 2. 2 What is Zamzee?
- 4. 4 • Rapid Feedback • Incentive Motivation • Intrinsic Motivation
- 5. 5 • Rapid Feedback • Incentive Motivation • Intrinsic Motivation
- 6. 6 • Rapid Feedback • Incentive Motivation • Intrinsic Motivation
- 7. 7
- 8. 8
- 9. 9
- 10. FOR INDIVIDUALS & GROUPS 10
- 11. 11
- 12. How do we TURN THE TIDE? 12
- 13. 13 Reimbursement = Sustainability
- 14. TURNING THE TIDE Invitation #1 – Building the Case • Broader body of evidence • Health outcomes • Cost impacts • Ideal evidence partners • Pediatric weight management clinics with research capacity • Research trials with physical activity outcomes
- 15. TURNING THE TIDE Invitation #2 -- A Design Roadmap 1. What outcomes must be demonstrated? 2. How can we reframe the cost discussion? 3. How can we best harness new technology and behavior change? 4. What will it take for childhood obesity prevention to become a covered benefit?
- 16. TURNING THE TIDE Invitation #3 • Childhood Obesity recommendation review in 2015 • Opportunity for Public Comment: Obesity and Weight Management in Children and Adolescents: Screening and Interventions • Submit comments on the analytical framework by Nov 19 • Go to http://www.uspreventiveservicestaskforce.org
- 17. Working Together To TURN THE TIDE On Childhood Obesity Continue the conversation @ Exhibit #316 and @Zamzee A project of
- 18. A project of
- 19. A project of SPARE SLIDES
- 20. $147B in Annual Healthcare Costs Obesity Rates Have More than Tripled… 5.0 16.9 1971-74 2009-10 40% of Children Will Develop Type 2 Diabetes… 40%
- 21. 20% 15% 10% 5% 0% Childhood Obesity Rates 21
- 22. THE SEDENTARY BEHAVIOR CRISIS Nader, Philip R., Bradley, Robert H., Houts, Renate M., McRitchie, Susan L., O’Brien, Marion (2008). Moderate-to-Vigorous Physical Activity From Ages 9 to 15 Years. JAMA, 300(3), 295-305. Physical activity ages 9 – 15 years 22
- 23. 140 120 100 80 60 40 20 0 Control Zamzee Moderate-vigorous physical activity (minutes / week) Kids using Zamzee move 59% more ZAMZEE WORKS 23
- 24. SURGEON GENERAL’S WARNING: Smoking Causes Heart Disease, Lung Cancer, Emphysema and May Complicate Pregnancy. 24
- 25. IS SITTING THE NEW SMOKING? 25
- 26. SMOKING: MASS BEHAVIOR CHANGE Per Capita Cigarette Consumption (US, Adults) 1964 Surgeon General’s Warning Research 1940-50 Early studies link smoking to cancer 1970s Research shifts to how to quit/addiction Public Policy Communications Healthcare 2010 ACA expands access to cessation Focus on addiction creates demand for interventions 3,500 4,250 4,000 3,900 2,900 2,100 1,300 1969 TV/Radio ads for cigarettes banned 1950 1960 1970 1980 1990 2000 2010 26
- 28. 28
Hinweis der Redaktion
- Welcome. First, thank you Donna Spruijt-Metz and Brie Turner-McGrievy for the opportunity to speak with you tonight. And congratulations to Sherry Pagoto for your work and the honor you received tonight. I am Lance Henderson, CEO of Zamzee. Zamzee is a family-targeted, technology-based physical activity intervention designed to integrate into comprehensive treatment programs for a variety of conditions – pediatric weight management chief among them. We are a project of HopeLab, a non-profit using research-driven technology design to promote human health and thriving. I plan to give you a quick overview of Zamzee’s work and the evidence of our impact, but then I would like to talk about the context for our work and the challenges I see that are linked to turning the tide on childhood obesity. I hope it is not off script, but I am not here to just talk to you about Zamzee. Zamzee is but one example of the types of mHealth innovations that, despite promising evidence, are often difficult to scale in the healthcare sector. And the reasons for this need to be addressed if we are to turn the tide on childhood obesity. Later in my comments I pose a few questions for us to wrestle with and make an invitation to join us in this effort. But first, so you have some context, a bit about Zamzee. Our mission is two-fold. 1) We want to get kids and families moving. 2) We also want to get evidence based preventive services like Zamzee to be valued and paid for within the healthcare sector. We are trying to shift the sector so that lifestyle and behavior change programs – whether they be for physical activity, nutrition or other behavior impacts are <when the evidence supports it > covered benefits. In my opinion, this is the only way that programs can be sustainable and delivered at the scale that is necessary turn the tide on childhood obesity.
- Zamzee is an evidence-based tool that we can put directly into the hands of kids and families – a tool that makes physical activity a fun, effective part of everyday life. Zamzee is designed especially for kids, to establish healthy patterns of behavior before risk factors for diseases take hold, and it’s a tool the whole family can use and enjoy. In fact, we see the best engagement when kids use Zamzee with their parents and siblings.
- Zamzee is delivered as a program that includes a physical activity tracker, mobile app and motivational website that inspires kids to be more active. The tracker itself is different from other consumer targeted activity trackers, in that it measures MVPA, rather than steps. In that sense, it is a more rigorous, research ready tool than step counters. Unlike other research-targeted trackers, the Zamzee is also an intervention, developed with behavior change insights at it’s core.
- The website and mobile app were developed using a user-centered, iterative design process leveraging three main principles of motivational science. First, is rapid feedback – by giving the kids compelling, meaningful information they understand in their own terms regarding how much they are moving. We do this by focusing on improvement – specifically beating your own average daily, and points – a detailed algorithm of factors than encourage daily physical activity
- The second is the use of incentives – rewards. Incentives can be controversial, but our research has shown that the use of properly measured, limited, rewards can have an measurable impact on outcomes. The rewards, in effect, kickstart the behavior change.
- But to sustain that change, Zamzee fosters intrinsic motivation. We use a motivational framework that cultivates purpose, connection and control – specifically designed into the experience. ------------------------------------------------------------- Competence (goal-setting, stars/rewards) Autonomy (avatar choice of look/feel, rewards, activity) Mastery (leveling up, accomplishing challenges) Purpose (challenges, health of me, health of my family) Relatedness (social board, whamz, offline social interaction)
- But the key question is – does it work? The Zamzee program was tested over the course of 11 randomized controlled studies, including a final impact trail that randomized 448 kids ages 11-14 at four study sites. This final study was for six months and demonstrated the following: --------------------------------------------- 10 randomized controlled pilot studies 577 tween participants, 6 national study sites 4-15 weeks each >8.5 million min of activity monitoring These studies included reward amount, benchmark, reward schedule The 11th study was a a 6-month 448 child randomized controlled study. Study done in a school setting. Ages 11-14 54% female 55% Ethnic minority 25% BMI > 25, 8% > 30 25% of the participantsp
- Kids who used the full Zamzee experience showed a 59% increase in MVPA over the control group who only had the accelerometer without access to the motivational website. And of importance to treatment settings, the kids with a BMI > 25 showed a 27% increase ------------------------------ For girls, 103%
- As secondary outcomes, we tested for key biomarkers and found statistically significant impacts on cholesterol and blood sugar. We expect these promising results to be published in 2015. ----------------------------------------- No significant effect on BMI but this was not an aim of the study – the primary aim was to study the impact on physical activity.
- Based on these results, Zamzee is now being piloted in health care settings across the U.S. -- to test Zamzee in real world settings and further develop the tools that help clinicians implement the program. As a result of this work, we now have a portfolio of tools that allow clinicians to measure, motivate and manage physical activity in their patient populations. We’ve seen great results so far with some of the countries most influential health care providers.
- One of our primary goals with healthcare providers is to determine if Zamzee, when integrated into existing clinical programs like those that many of your manage, accelerates the desired outcomes. Some of what we have seen so far is promising: 1) While many programs don’t have clean baseline data, some do. In one program, for example, we saw kids drop twice as much in “% overweight” compared to the baseline group. 2) In another study, we saw an improvement in program completion of 57% compared to five previous cohorts that had participated without Zamzee. 3) But as importantly, the the ability to simply view actual activity – instead of rely on self report – has been of enormous value to our partners. These are promising outcomes and we are now faced the the questions of how to bring this type of intervention to scale.
- So with that context on Zamzee, let me pose a broader question… How do we turn the tide on childhood obesity? Zamzee has seen promising results with patients and in clinical settings. Yet we find ourselves confronting one of the paradoxes of healthcare in this country – the variety of incentives that favor treatment of disease over prevention. To be clear, I have no issue with treatment when it cannot be avoided but certainly we have an obligation to invest as well in tools to prevent obesity. From our experience, in the absence of being covered benefit, it is hard to scale a solution like Zamzee in healthcare settings where funding for childhood obesity programs is scarce. And assuming many of you would benefit from having tools like this in your tool chest, these challenges to scale are challenges that we share.
- Zamzee is not alone, and hence our concern is not just about scaling Zamzee. The fact is that there are many promising innovations being developed and tested in the “mHealth” space. But, in our experience these innovations have too few resources, are delivered in fragmented ways and for too little time to catalyze and sustain behavior change. For these innovations to scale, financial mechanisms, like reimbursement, must be aligned with the goals of prevention. Reimbursement = sustainability – that is what it is going to take to turn the tide. Without tools for preventing and treating obesity being a covered benefit, they will not become broadly accessible to clinicians and their patients. And to get to reimbursement, we are going to have to work with you to develop more integrated approaches, build greater evidence of the health and cost impacts of interventions, and build a movement of providers, payers and policymakers that demands a better future for our kids. And that is why we welcome the opportunity to talk with you. Tonight I have three specific invitations for your to consider in joining with us. --------- Healthcare is under enormous cost pressures, disease manifestation for kids is often far in the future and, despite promising evidence, there is not enough of it to convince physicians that lasting behavior change and long term health benefits will be real.
- First, we need partners – some of you sitting here tonight – who can help us engage in rigorous testing and further development of our program, your program, other programs – to build the body of evidence – on health outcomes and cost impacts -- in a variety of healthcare and research settings -- that will eventually tip the scales in favor of covered benefits. We are already doing this work with several leading healthcare payers and providers, but a broader efforts is needed to build the breath of evidence that will lead to reimbursement.
- Second, one of the problems I observe is that we too often design solutions without targeted outcomes clearly defined. We develop partial solutions, pilot them in fragmented ways and then ask if the outcomes are good enough. What if we came up with the targeted outcomes first and then designed for these outcomes? Toward that end, I offer a few questions – questions we need you (and others) to help answer so that we can, together, do just that. So here are the questions I pose: What outcomes from childhood obesity interventions must be demonstrated to support broad adoption by providers and payers? How can we reframe the financial discussion so that the full costs of obesity to society are accounted for in evaluating the cost and benefits of prevention programs? How can we harness new technologies and insights from behavior change science to develop effective childhood obesity interventions? What will it take for childhood obesity interventions to become a covered benefit in private health plans and in Medicaid so that they are available to all kids and families?
- My third invitation relates to the USPSTF childhood obesity recommendation which is up for review in 2015 As it turns out, they are collecting public comments NOW through Nov 19 on the framework they will use in 2015 to develop their recommendation. There are no better people to provide such comments than people sitting here in the room. If you have an interest in this effort, let’s talk. This is a once-every-five-year opportunity to influence the national guidance on prevention programs for childhood obesity.
- I want to finish by noting, with humility, the vast experience and talent that is assembled in this room and at this conference. Despite all the incredible efforts underway, in our on=the=ground experience, we see the systemic barriers that are preventing the sum of the efforts from turning the tide, and we want to be both advocate and partner in reversing this threat to our nation’s health. Thank you. If Zamzee’s work interests you, or if you would like a more detailed look at the Zamzee program, please come speak with us tonight and over the course of the conference.
- Welcome. Lance Henderson, CEO of Zamzee. Zamzee is a family-targeted, technology-based physical activity intervention designed to integrate into comprehensive treatment programs for a variety of conditions – pediatric weight management chief among them. We are a project of Hopelab, a non-profit using research-driven technology design to promote human health and thriving. Our mission is two-fold. We want to get kids and families moving. But more than that we want to get evidence based preventive services like Zamzee to be valued and paid for within the healthcare sector. We are trying to shift the sector so that physical activity programs, or nutrition programs, or a host of other similar types of programs are <when the evidence supports it > covered benefits.
- As a starting point – let’s look at the costs. No one understands the health, social and financial costs of childhood obesity better than the people in this room. Rates are tripling Costs skyrocketing Some projections indicate that 40% of U.S. children born today will develop Type 2 diabetes in their lifetime. Childhood obesity is a five-alarm fire. The people gathered here this week have responded. Activists and practitioners have responded. But the vast healthcare industry, in particular the mechanisms that drive reimbursement and underlying economics have not. Public relations campaigns, public service announcements, and other laudable projects have raised awareness. But prevention of childhood obesity needs a more sustained, scaled, multi-sector approach. Recent signs of gradual slowing in the growth of obesity rates is not cause for celebration, it is instead a sign of the limited impact our efforts to date have had. We must do better unless we are content to live in a world where our children live shorter lives than we do.
- The key motivator behind Zamzee is that daily physical activity declines dramatically starting at age 9. Sought to create an intervention targeting this age range to increase daily MVPA
- Scientific research shows it does. In a study sponsored by HopeLab and the Robert Wood Johnson Foundation, we found that over a 6-month period, kids using Zamzee moved 59% more than a control group. We also saw positive impact on cholesterol and blood sugar levels. In other words, Zamzee helped address the biological risk-factors for many of the lifestyle diseases threatening our health. ________ NOTE: The study enrolled 448 kids at sites across the U.S. to measure the impact of Zamzee over a 6-month period. Girls moved 103% more, and obese/overweight kids moved 27% more. Zamzee was developed and tested through a series of 12 randomized controlled studies, culminating in the 6-month impact study. [*ClinicalTrials.gov: NCT01433679; Funded by HopeLab and Robert Wood Johnson Foundation Read more about HopeLab Zamzee Research Results at: http://www.hopelab.org/innovative-solutions/zamzee/zamzee-research-results/]
- The successful campaign to reverse the trend in smoking rates, led by the Robert Wood Johnson Foundation and many others, offers a possible template for the fight against sedentary behavior.
- Can we mount a similar cross-sector assault on sedentary behavior? Is sitting the new smoking?
- This is the history of per capita smoking in the U.S. It peaked 50 years ago at the Surgeon General’s landmark report 42.4% of population smoked in 64 (now 19.3%; 42 MM Americans now smoke) So progress is gradual, but real; social change doesn’t get solved – it evolves. Research was the start Smoking: First studies linking cancer were in the 40s/50s Sedentary Behavior: Scientific journey well underway – evidence and science important; lead the way There is decades of research behind us on the positive impact of physical activity. There is growing consensus that exercise is the best medicine available today. There is a robust body of evidence on the impact on not only obesity but a host of other conditions and risk factors, such as diabetes, asthma, cancer recovery and more. Policy changes advanced the issue Smoking: Research led to Surgeon General’s report 50 years ago Began a cascade of policy changes: advertising restrictions, airline and indoor smoking limitations, etc. SB: First surgeon general report on PA in 1998 Efforts underway to bring PE back to schools and promote active play (KaBOOM!); build safe and walkable neighborhoods (Safe Routes to Schools) Also Partnership for a Healthier America, National Coalition for Promoting Physical Activity and Design to Move Communications shifted public perceptions Smoking: Ad bans in 1969, warnings on cigarette packages – eventually to “don’t trust the tobacco industry” in the early 2000’s SB: Let’s Move and NFL Play 60 are communications efforts that are raising awareness and promoting PA The healthcare sector shifted as a result Smoking: Started with “you should quit smoking” – as ineffective as a doctor saying “move more” – but that is the standard of care today Research shifted to how to quit which led to the search for evidence-based behavioral interventions Over time, they proved themselves to work (a percentage of the time) – not perfect, but well enough to get paid for SB: We are at the “move more” phase with smoking We see us at this critical point of needed to prove that interventions can work The healthcare sector has not yet been meaningfully activated. There are few options for interventions, and even fewer covered options for interventions. ADDITIONAL DATA: Tobacco History: Smoking down 59% from 1964 Prevalence was 42.4% in ’65 down to 19.3% in ’10 Biggest from from 33.2% to 25.5% from ‘80 to ‘90 42 MM Americans still smoke 5 MM die worldwide/yr from smoking illness In ‘58, 44% believed tobacco caused smoking By ‘68, 78% did Cigarette warning by Congress in ‘65 but not implemented until ’71 ’86 was Koop’s report on 2nd hand smoke ‘89 ban on domestic flights and communities began to ban indoor smoking Not great data on sedentary behavior 1/3 of kids are obese or overweight 47% of kids spend more than 2 hrs in front of screen
- Ultimately, these shifts led the healthcare sector to provide tools to consumers to end smoking behavior. The debate around insurance and smoking cessation programs, it is a virtual carbon copy of the conversations we are having today. Are these programs effective? What’s the proof? Are they COST-EFFECTIVE? Over what time horizon? What’s the proof? Is this even something that Health insurance should cover anyway? In the end, rational science and economics won the day – and now smoking cessation is widely covered. ACA now requires coverage of Tobacco Use Screening and cessation interventions for tobacco users Smoking cessation programs became a covered healthcare benefit – a critical step in reversing the smoking trend. In this context, Zamzee and much of the great work being done by people in this room are to sedentary behavior of weight management as cessation programs are to smoking. So, what exactly is Zamzee?
- The Zamzee program also includes tools for Pediatric Weight Management program leaders. These tools give the program leader real-time insights into patient engagement and physical activity levels – as well as overall program analytics to assess overall program impact.