This blog is a forum developed to facilitate discussion on key topics related to obesity and obesity-related diseases. And there are many topics to discuss!
Obesity continues to plague our nation and increasingly is the gateway to chronic illnesses like diabetes and hypertension. Patients, health care providers, employers, labor, government and insurance providers will all continue to be affected by the tremendous burden of this epidemic. As the STOP Obesity Alliance and its Steering Committee members continue our collaboration on efforts to take on this health crisis, we will take advantage of this forum to have an open dialogue with all of you.
Key contributors to Weighing In are STOP Obesity Alliance Steering Committee members, Christine Ferguson, the STOP Obesity Alliance Director and Dr. Richard H. Carmona, the Health and Wellness Chairperson of the Alliance.
The STOP Obesity Alliance Health & Wellness Chairperson, 17th U.S. Surgeon General Dr. Richard H. Carmona, facilitated a panel discussion for the launch of the Obesity GPS - featuring the Alliance's Director, Christine Ferguson, the American Medical Group Association's Julie Sanderson-Austin, and the American Heart Association's Dr. John Ring.
By Carl Graziano, DMAA: The Care Continuum Alliance and Liza Greenberg, AAPPO
In June, the American Association of PPOs and DMAA: The Care Continuum Alliance co-hosted a webinar on best practices in treatment of obesity. Dexter W. Shurney, MD, MBA, MPH, co-chair of the DMAA: The Care Continuum Alliance Obesity Workgroup, gave an overview of the rising tide of obesity in America and noted that obesity is closely linked to a host of chronic diseases, including diabetes and heart disease. While preventing obesity represents our best hope for heading off an expected avalanche of chronic disease, we also need real solutions to the two-thirds of Americans who are already overweight, the one-third who are obese and the six percent with extreme obesity (body-mass index (BMI) greater than or equal to 40). The webinar, funded by Ethicon-EndoSurgery, featured a panel of experts discussing what we know about a variety of treatments – from the effects of diet and exercise to medications and obesity surgery.
Neil F. Gordon, MD, chief medical and science officer, Nationwide Better Health, presented information from the DMAA: The Care Continuum Alliance Obesity Toolkit that looked at published results from studies of obesity treatment. Dr. Gordon commented that 1998 obesity treatment guidelines from the National Institutes of Health are out of date and updated guidelines, due for public comment in spring of 2011, are urgently needed. It’s clear that caloric restriction and exercise are essential elements for weight loss, but practitioners need better tools and information on how to treat patients for weight loss. Medications can be effective if combined with a program of diet and exercise. The key to success is being willing to try different combinations, to continue trying and to support patients in making positive changes to reduce weight. Most importantly, practitioners need guidance on targeting specific weight loss treatments to varying patient populations.
David B. Sarwer, PhD, director of clinical services, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, discussed surgical treatment of obesity. Bariatric surgery is a most effective treatment resulting in long-term weight loss for individuals who need to lose a significant amount of weight. Dr. Sarwer said that expectations of weight loss associated with different procedures vary. For any type of bariatric procedure, the greatest total weight loss occurs approximately one year post-surgery, with slow regain and eventual stabilization of weight loss. Another major benefit of weight loss surgery is its impact on chronic disease and risk factors – after bariatric surgery, 71 percent of patients see an improvement in high cholesterol, 77 percent see a reversal of type 2 diabetes and 61 percent see their blood pressure return to normal.
So how does the knowledge of obesity treatment get translated into health benefits? According to Dr. Jim Cross, Aetna’s Head of National Policy and Operations, health plans routinely offer an array of programs to prevent weight gain and help members with weight management, such as discounts on gym memberships, encouraging physicians to discuss weight with members and including weight assessment and counseling in wellness and disease management programs. But for the severely obese, treatment options are not routinely available.
There is a disconnect between what employers are paying for the health care costs of obesity and what they are willing to do to treat obesity as the chronic condition it is. Employers reportedly pay approximately $1,400 more per obese person per year in health care costs. Yet health plans typically exclude weight management drugs and surgery unless their customers specifically opt into it and pay for it as a “rider.” And insurance plans say that employers want it that way to keep costs down. While insurance companies say evidence is weak for the effectiveness of medications at helping people achieve significant and sustained weight loss, evidence does show that bariatric surgery works for the right patients, most of whom are steered toward “centers of excellence” to get the best results. For more details on bariatric surgery and health plan considerations, see the series of issue briefs available from AAPPO.
Where does all this lead us? There’s no one single way to treat obesity. But until we can reverse the tide of people becoming obese, we need to invest more time and energy in developing effective methods to turn obesity around and getting those methods out into the field. That means addressing severe obesity as the chronic relapsing condition it is, developing programs, services and guidelines for physicians and offering health benefits that reflect the best possible evidence.