Guest Columnist
Obesity in America: Is there a Doctor in the House?
By
Feb 2, 2010 - 10:30:47 AM

(HealthNewsDigest.com) - As the Primary Care Shortage Looms Ahead, How Will We Address the Nation’s Obesity Epidemic in 2010 and Beyond?

Whether Congress finds a way to pass health care reform or not, there is one reality that we’ll have to confront one way or another in 2010: the shortage of primary care physicians.

Last year, the U.S. Department of Health and Human Services estimated that there is an immediate need for at least 16,000 more primary care physicians – a shortage that may grow to as much as 125,000 by 2025.

Despite efforts to encourage more medical students to enter primary care, it is inevitable that primary care physicians will continue to be stretched thin as the health care system begins to absorb more uninsured Americans seeking medical care.

While the primary care shortage is troubling for a variety of reasons, it is particularly disconcerting when it comes to identifying interventions that will help the 64 percent of Americans that are already overweight and obese. According to new data from the CDC, we finally have a bit of a reprieve on the growth of overweight and obesity, but reaching a plateau cannot mean we hit a wall on progress.

The statistics still startle: CDC estimates that more than one-third of adults, or about 72 million Americans, are obese. The condition is linked to a litany of chronic diseases, including type 2 diabetes, heart disease, asthma, depression and even certain types of cancer. Obesity is also associated with significant costs to the health care system – over $147 billion each year, as Finkelstein noted recently.1

In short, America’s weight problem is at a tipping point. And our nation’s doctors may not be prepared to address it.

A New Perspective in the New Year

The overwhelming health and financial realities require those of us who are involved in the practice and policy of health care in America to take a new perspective in 2010. It’s time to shift our thinking away from viewing obesity strictly as a matter of personal choice, and towards approaching it as a medical condition demanding professional guidance and support.

Of course, we understand that’s easier said than done, for several reasons.

To start, few Americans actually look to their physicians for help losing weight. As such, during their limited time with the doctor, weight often takes a back seat to more immediate medical issues, with more specific treatments.

Furthermore, primary care physicians continue to struggle with major barriers when addressing obesity. Many health care providers feel as though they lack adequate time, training or evidence-based models for treatment. Others may lack the means to effectively track their patients’ progress. Reimbursement for weight counseling can be unclear and uncertain. And to top it all off, some doctors fear offending, alienating or losing patients by confronting what they consider to be a sensitive and highly-personal issue.

These issues may, in fact, only be the tip of the iceberg when it comes to the challenges of treating obesity in the primary care setting. We have a culture that stigmatizes obese individuals and puts a premium on unrealistic definitions of successful weight loss. Both serve as subtle but undeniable obstacles to physicians’ best efforts.

But there is potential for progress in 2010. Although Congressional leaders are reconsidering how to move forward on health reform, the momentum generated by the national conversation about health care may have advanced some ideas that are too important to stop, including coordination of care, medical homes, community programs and electronic medical records.

Care Coordination

As the primary care shortage becomes clearer, we will hear more about the importance of coordination of care among primary care physicians, nurse practitioners, specialists and other health professionals.

A variety of health professionals will be asked to step into broader roles to support overburdened primary care offices. Many – including nutritionists, physical therapists, nurses and others – hold particularly valuable assets in the effort to address obesity. In collaboration with primary care physicians, these health professionals could offer tailored interventions and invaluable follow up for obese patients in a way that monitors and encourages maintenance of weight loss. Moreover, they offer the potential of an approach that supports a healthy medical professional-patient relationship through effective communication, honest dialogue and a team approach.

This type of comprehensive, coordinated and patient-centered care is at the foundation of the medical home model. And while the medical home might not be the hot topic that is was a year ago, it holds true potential in supporting weight loss efforts in primary care.

It Takes a Village

As the CDC noted in a 2009 report, “it takes a village” to successfully overcome obesity. And that requires looking beyond the individual.

The CDC’s recommended strategies for combating obesity reflect the critical influence that our communities play in encouraging and reinforcing the healthy lifestyles that are paramount to overcoming this epidemic.

By looking towards our own “villages”, we can give people struggling with obesity more targeted care in their communities after they leave the doctor’s office. For example, by working in partnership with accredited staff trained in appropriate weight management programs, physicians can find partners in community-based gyms or recreational organizations to foster an ongoing and actively managed treatment program. This type of partnership could be particularly helpful for primary care physicians in solo practices or in rural regions, where they stand to be stretched even further than other doctors.

The Promise of Technology

Another key resource in the effort to coordinate care is the overdue concept of electronic medical records (EMRs).

The standardization and ease of information sharing may help close the gap between primary care physicians, allied health professionals and hospitals. Just as importantly, it might also allow primary care physicians to more effectively track patient progress in weight loss programs and identify changes in a patient’s vital signs over time, including weight, blood sugar and blood pressure.

Furthermore, by tracking and trending the results, EMRs could help physicians gather outcomes data within a practice, better understand their patient population and identify areas for improvement. This benefit could be particularly meaningful in the management of obesity – a treatment area that has historically been hindered by the lack of a sufficient evidence base.

Looking Forward

One thing that we have learned in the battle against obesity is that there are no “magic bullets.” Obesity is a complex issue which requires a sophisticated response. The same could be said about the looming crisis in primary care. What is clear though is inaction on these challenges in 2010 could lead to catastrophic outcomes in the future.

Progress on both the obesity and primary care fronts will require an approach that embraces coordinating care, sharing information and leveraging the unique skills of a diverse group of health care professionals.

Primary care may stand as the first line of defense to overcoming obesity, but it should not stand alone.

Christine C. Ferguson, J.D.
Director, Strategies to Overcome and Prevent (STOP) Obesity Alliance

Christine C. Ferguson, JD is charged with coordinating the day to day activities of the Strategies to Overcome and Prevent (STOP) Obesity Alliance – a prestigious and diverse group of patient, provider, labor, business, insurer, and quality organizations formed to change America’s approach to obesity. In addition to her role with the STOP Obesity Alliance, Ms. Ferguson is a member of the faculty at the School of Public Health and Health Services at the George Washington University.

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