Sunday, October 16, 2011

To BMI or Not to BMI, That is the Question: Update on the Governor's Health Initiative

(This updates the discussion regarding the Governor’s Health Initiative and collecting Body Mass Index (BMI) data, begun in my September 18 post at First Impressions on Governor Snyder’s Message re Health and Wellness; BMI Reporting?)

The Joint Committee on Administrative Rules (JCAR) met on Oct. 6 to discuss a significant portion of the governor's new health initiative.

As the chair of JCAR, I convened this meeting to hear testimony on the proposal by the Department of Community Health (DCH) to ask physicians to submit the Body Mass Index (BMI) of children into the Michigan Care Improvement Registry.

The main testimony was provided by Olga Dazzo, director of DCH. The primary concerns I have heard from the public over this new rule: whether the gathering of the information will be voluntary and how confidential is the data. In other words, people are very worried about their privacy.

Director Dazzo told JCAR that the reason for collecting this data is threefold: to put greater attention on the epidemic of obesity, to provide a body of research data, and to provide tools to physicians they can use in counseling their patients. Gov. Snyder's administration is all about measurement of goals - and the BMI tool gives physicians and the state health agencies a benchmark from which to measure progress.

What I learned at the hearing is that this is a voluntary program on the part of both the physician and the parent, but in slightly different ways. It is an opt-in system by the physician. They can participate in this program or not at their discretion. On the other hand, for a parent to have their children's information excluded, they have to affirmatively opt-out. The reason stated for the difference is DCH doesn't believe enough parents will opt-in to the program.

The BMI data will be more confidentially protected than the immunization data that's already in the Michigan Care Improvement Registry. The proposed rule provides that only physicians may access it under very tightly controlled circumstances. Immunization data may currently be accessed by a wider range of users. The data available to researchers would only be available in de-identified aggregate form - which means it will be anonymous.

A major question that stood out at the hearing is whether this is a cost-effective thing to do. There is some cost at the state level, but it is modest. The benefits are uncertain - because no program of this kind has been implemented to date. Until the BMI reporting begins, there is no way to tell whether or not it will reduce obesity.

The great hope of the governor's office and DCH is that Michigan will see the same success for the BMI reporting program as our state currently has with the immunization program. When the care improvement registry began collecting vaccine data, there were significant increases in immunizations. Whether the immunization data and BMI data is comparable has yet to be determined, but I am skeptical that the same positive impact will occur with BMI data collection. Every parent must submit their child's immunization records to the schools to be admitted, or affirmatively opt-out. People's views about immunization are different from those about obesity - after all, no one's child can catch obesity from another child. Obesity is not contagious.

The second question on whether this will do much good is whether we will learn more from the information in the registry than we do from a general population survey. If physicians are not opting-in to the program and parents are opting-out, any data collected will be incomplete. The data may even be skewed, because certain segments of our population have greater access to medical care than others.

The bottom line is this: there is resistance to the BMI reporting rule. Based on what I've heard from both sides, this is far from a clear-cut decision. The hearing was very worthwhile in terms of public exposure to the details of the proposal.

Overall, the BMI rule is in test drive mode. If it collects valuable data, it's likely that DCH will work to make the program permanent so that we can work toward a healthier Michigan. If no one wants to participate, it'll likely go the way of other unpopular data collection programs, never to be heard of again.

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