Reaching for You

Treating Obesity: Ya Gotta Want It?

Where do otherwise thoughtful people get the idea that an essential hurdle for treating obesity is proving that a patient deserves it? In the midst of a generally intelligent review by U.S. News & World Report of recent advances in options for obesity care are these nuggets of nonsense:

The drugs can’t melt away the fat while you sit on the sofa for a Netflix marathon, but they can help kick-start the lifestyle habits crucial to dropping pounds.

We don’t have a miracle drug where you can stay in bed all day and lose weight.

Of course, there’s no evidence that any obesity drug works by “kick-starting” lifestyle changes. All four newly approved drugs work on neurological mechanisms that serve to regulate weight. The possibility of “Netflix bingeing” only surfaced in 2013, so no, you can’t blame it for obesity. And who in the world has ever pursued the “stay in bed all day” weight management program?

But it’s not just health reporters who pollute their thoughts with such flawed ideas. Payers routinely write them into reimbursement guidelines. Notably, CMS specifies that people who don’t lose enough weight in the first six months of intensive behavioral care for obesity are kicked out for six months and then must prove their “readiness to change” before receiving any more care. Tough love is not an evidenced-based treatment.

In a similar vein, requirements for documentation of prolonged preoperative diet efforts before health insurance will approve bariatric surgery services are common. Such practices are clearly “inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence” to support them, say leading experts of the American Society for Metabolic and Bariatric Surgery (ASMBS).

It’s little wonder that the costs of untreated obesity continue to pile up.

Click here to read the item from U.S. News and here to read the position statement of ASMBS.

Reaching for You, photograph © Maria Teresa Ambrosi / flickr

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August 29, 2015

4 Responses to “Treating Obesity: Ya Gotta Want It?”

  1. August 29, 2015 at 10:08 am, Laure DeMattia said:

    Thank you for highlighting this continued expression of shame against people that are dealing with obesity. This language would never be seen in an article discussing diabetes, hypertension or cancer treatment.

  2. August 29, 2015 at 10:43 am, Ted said:

    My thought exactly, Laure. Thanks for sharing your view.

  3. August 30, 2015 at 9:43 pm, EJHarman said:

    Wow — the stupid comment by the reporter was sad enough but the second quote by the physician is irresponsible and totally inappropriate.

    “Says Bartolome Burguera, an endocrinologist and director of the obesity programs at the Cleveland Clinic: “We don’t have a miracle drug where you can stay in bed all day and lose weight.”

    Perhaps that was not exactly what he mean but nonetheless what an awful thing to say, intended or not.

    Sad sad — what will change this need to shame people with obesity? Thanks for your blog.

  4. August 31, 2015 at 4:39 am, Ted said:

    Thanks for taking time to comment. I give Burguera the benefit of the doubt, because reporters have a way of fishing for the quote they want. It’s hard to know, but I think that quote reflects the reporter’s attitude as much or more than Burguera’s.