Cleaning Up

Neglecting Obesity and Cleaning Up Later

This week brings great news about accomplishments in cleaning up the mess created by neglecting obesity. Two studies show that all the money we’re spending on treating diabetes and cardiovascular disease is paying off. Complication rates are dropping and fewer patients go untreated. Meanwhile, a third study shows that three quarters of primary care physicians fail to assess BMI and regularly provide appropriate follow-up.

In the New England Journal of Medicine (NEJM), investigators documented a sharp drop in the risk of complications from diabetes over the past two decades. Heart attacks, strokes, kidney failure, and amputations were all down. The biggest drops came in the rates for heart attacks and deaths from high blood sugar. The reduction in these two outcomes was more than 60%.

Then in Obesity, a new study showed that untreated hypertension and high cholesterol have both dropped significantly over the last decade in people with excess weight and obesity. While we’ve done little to reduce the rising prevalence of excess weight and obesity during that time period, we have more aggressively treated the cardiovascular risk factors that result.

Finally, a study in the American Journal of Health Promotion looked at the practices of primary care physicians with regard to obesity and energy balance. While they found some variation among different specialties, an overwhelming majority (74%) were not systematically assessing BMI and addressing it in their practices.

The pattern could hardly be more clear. Primary care is not doing much to address obesity, but when it leads to other chronic diseases, our sick care system is jumping in with both feet. As a result, the cost of diabetes in the U.S. was estimated to be $245 billion in 2012. In 2010, the cost of heart disease in the U.S. was estimated to be $444 billion.

Can we afford to continue neglecting obesity and then cleaning up the mess?

Click here to read more in the New York Times, here to read the study in NEJM, here to read the study in Obesity, and here to read the study in the American Journal of Health Promotion.

Cleaning Up, photograph © atomicjeep / flickr

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