certifying entities such as medical specialty boards included questions about these areas in their formal examinations, this would provide an incentive to students and residents to master the associated material. Programs such as the Nutrition Academic Award Program sponsored by the National Heart, Lung, and Blood Institute have begun to focus attention on improving nutrition education efforts in medical schools (Pearson et al., 2001), and further efforts are needed regarding other relevant areas. A recent Institute of Medicine report confirms the need for expanding behavioral and social-science content in medical schools’ curricula (IOM, 2004). Health-care professional schools, postgraduate training programs, continuing professional education programs, professional organizations, and certifying entities should require knowledge and skills related to obesity prevention (e.g., child and adolescent BMI interpretation, nutritional and physical activity counseling) in their curricula and examinations.

Health-Care Insurers, Health Plans, and Quality Improvement and Accrediting Organizations

Until recently, health-care concerns had largely focused on the treatment—as opposed to the prevention—of obesity, particularly the severe forms of adult obesity. But epidemiologic data showing increases in the numbers of obese children and youth, along with a rise in the prevalence of type 2 diabetes (formerly termed “adult onset diabetes”) and increased hypertension in children (Muntner et al., 2004), have raised awareness that childhood obesity might be best addressed from a prevention perspective. Furthermore, the high economic costs of obesity (Chapter 2) provide incentives to health-care insurers and health plans to encourage healthful lifestyles and thereby reduce their costs.

The health-care insurance industry in particular has several paths by which it may address obesity prevention. For individuals and their families, health insurance companies and health plans can develop innovative strategies for encouraging policy holders and their children to maintain a healthy weight, increase their levels of physical activity, and improve the quality of their diet. Creative options may include incentives for participating in and documenting regular physical activity, or programs that provide discounts or other incentives for wellness-related products. For example, one insurance company includes discounts on health and wellness magazines as well as lowered fees for health club memberships and weight-reduction programs for adults (CIGNA, 2004). Furthermore, health-care insurers can take an active role in community coalitions and other activities; one example is the Jump Up and Go Program in Massachusetts (Blue Cross Blue Shield of Massachusetts, 2004). It will be particularly important for healthcare insurers and health plans to consider incentives that are useful to high-



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