Actions for Providers
The Indian health care system, including IHS, Tribal, and urban Indian health programs, has the potential to play a major role in helping patients achieve and maintain a healthy weight across the lifespan. Health care providers, nurses, dietitians, pharmacists, public health nutritionists and nurses, community health representatives, and others can influence patients' dietary choices and physical activity behaviors. As shown in the Social-Ecological Model, health care team members can also collaborate with schools, community groups, and worksites to help educate and reinforce healthful eating and regular physical activity, and they can advocate for health care policy changes to help effect change.
- Develop a policy on bundling of screening measures (so-called "advanced vital signs"), including BMI and physical activity. Bundle age-specific measures for children's BMI documentation with physical activity, nutrition, screen time, healthy beverages, and others.
- Gather and provide accurate and timely clinical data, following clinical guidelines, on BMI for all patients across the lifespan. Measure height and weight and calculate BMI. Put data in patient charts, and track BMI trends.
- Work collaboratively with the IHS workgroup that addresses accountability measures regarding specific obesity measures as informed by Government Performance and Results Act (GPRA) and Clinical Reporting System (CRS) Part 1.
- Ensure that appropriate anthropometric measurement devices are available at all IHS-funded sites.
- Educate all health care personnel on accurate measurement of height and weight and on the use of BMI-for-age as a tool for assessing growth and development.
- Heighten the role of agency coordinator(s) for data collection and reporting of trends in weight for people at all ages to build a comprehensive database and surveillance system.
- Promote and implement universal, age-appropriate physical activity screening across the lifespan.
- Offer nutrition education and weight management counseling to all women planning pregnancy and to pregnant women.
- Screen all pregnant women for gestational diabetes at the first prenatal visit and at 24-28 weeks of gestation.
- Assess weight gain pattern at each prenatal visit.
- Coordinate prenatal nutrition education and ensure access to optimum healthful foods through the Special Supplemental Nutrition Program for Women, Infants, and Children program (WIC).
- Offer intensive medical nutrition therapy to diabetic women of childbearing age to ensure healthy weight and excellent blood glucose control at the time of conception and throughout the perinatal period.
- Provide education to mothers and mothers-to-be (especially those with gestational diabetes) on the role of modeling and practicing healthful eating and physical activity.
- Provide education to pregnant women, families, community, and health care staff about the weight management and diabetes prevention benefits of breastfeeding.
- Intensify public health efforts to prevent maternal smoking before and during pregnancy because of the evidence linking maternal smoking to childhood obesity and diabetes control.
- Develop a breastfeeding-friendly culture policy based on the World Health Organization's Ten Steps to Successful Breastfeeding. Establish hospital policies to promote breastfeeding; encourage IHS direct hospitals to work toward Baby-Friendly Hospital designations.
- Offer breastfeeding support tools, education, and resources to community and health care personnel.
- Use the infant feeding tool in Electronic Health Records (EHR), Resource and Patient Management System (RPMS), and CRS to monitor trends and follow up with patients.
- Use the infant feeding tool to measure breastfeeding rates for 2-, 6-, 9-, and 12-month-old infants.
- Provide post-partum follow-up support for breastfeeding families.
- Provide mothers and families with resources for breastfeeding support, including contact numbers for national, state, and Tribal breastfeeding coalitions and IHS breastfeeding hotlines.
- Assist nursing mothers with practical and realistic strategies to continue breastfeeding even when they are separated from their infants by work, school, or other circumstances.
- Encourage accommodations for breastfeeding mothers at the worksite.
- Encourage access for breastfeeding employees to resources, such as hospital-grade electric breast pumps and WIC electric breast pumps.
- If mothers or families choose to bottle feed, provide appropriate education on feeding in response to hunger cues, weaning, timely introduction of solids, and avoidance of overfeeding.
- Offer nutrition education and weight management counseling to all women postpartum.
- Screen women with gestational diabetes for diabetes 6-12 weeks postpartum and follow up with subsequent screening for the development of diabetes or pre-diabetes.
- Implement food standards for hospitals and clinics addressing patient meal service.
- Implement food standards for worksites addressing employee cafeterias, vending machines, and food vendors that come on campuses, as well as foods served at IHS meetings and events.
- Implement procurement policies for food and formula.
- Implement human resources policy changes consistent with the food standards policies.
- Implement universal health education and awareness campaigns for individuals and families about healthful eating behaviors and increased physical activity to promote healthy weight across the lifespan.
- Encourage parents to support and model healthful eating and engage in regular physical activity with their children.
- Provide quality information about healthy weight management to patients, health care personnel, and communities through improved information systems and multimedia communications.
- Offer lifestyle intervention programs for individuals who are overweight. (E.g., provide the Lifestyle Balance program developed by the Special Diabetes Program for Indians to individuals and families through classes and support groups.)
- Mobilize local health advocates (community health representatives, health promotion/ disease prevention area coordinators, health educators, and public health nurses) to promote healthful eating and physical activity in the community.
- Incorporate traditional and contemporary Native healing and wellness, such as prayer, affirmations, sweats, dances, local medicinal and plants, acupuncture, yoga, and meditation.
- Promote and advocate for healthful eating and physical activity policies in schools, worksites, Tribal organizations, etc. (See suggested policies in "Healthy Weight for Life: A Vision for Healthy Weight Across the Lifespan of American Indians and Alaska Natives, Actions for Communities, Individuals, and Families.")
- Partner with local businesses and organizations to increase access to healthy food and opportunities for physical activity.
- Identify and disseminate evidence-based best practices regarding healthy weight management; promote consistent messages based on proven science and methods to improve effectiveness.
- Define the scope of services for healthy weight management and provide guidance to health care personnel by disseminating clinical care guidelines and standards of care.
- Assess already overweight or obese individuals for complications and co-morbidities. Provide counseling and/or medical nutrition therapy. Identify and refer patients to resources that promote personalized weight reduction, weight management, nutrition, and physical activity.
- Assess and address the behavioral and emotional components that affect an individual's weight and health. Integrate behavioral health into the primary care health care team. In collaboration with the patient, address physical, emotional, cognitive, and financial barriers and develop coping strategies.
- Conduct audits and assessments to monitor the quality of care provided to overweight and obese individuals.
- Incorporate a quality improvement effort focusing on healthy weight across IHS initiatives and programs (e.g., the Improving Patient Care program, the Special Diabetes Program for Indians, and the Maternal and Child Health initiative).
- Increase the number of registered dietitians who plan, facilitate, deliver, and evaluate services to support healthy weight management to meet standardized staffing ratios.
- Increase the number of other personnel who plan, facilitate, deliver, and evaluate services to support healthy weight management.
- Strengthen workforce skills and role modeling behaviors related to nutrition and physical activity by implementing staff wellness policies and programs.
- Emphasize training of health care personnel in behavioral modification and motivational interviewing skills in clinical and community settings.
- Train health care personnel to be culturally and empathically skilled in working with overweight and obese individuals and to present culturally sensitive, standardized information and curricula/materials. (The IHS Division of Diabetes Treatment and Prevention has best practices for nutrition and physical activity.) Increase awareness, training, and utilization of toolkits for health care personnel on documentation of nutrition and physical activity in the EHR and RPMS.
- Increase awareness, training, and utilization of evidence-based best practices regarding healthy weight management.
- Determine how to quantify the impact of obesity and overweight on agency resources.
- Make the case for the cost-effectiveness of prevention and treatment services to promote healthy weight across the lifespan.
- Promote third-party reimbursement for medical nutrition therapy and other services.
