The Challenge of Systematic Obesity Care

If you want some insight into the challenges of gearing up to deliver systematic obesity care, a new publication in Current Obesity Reports is well worth reading. For a full understanding, you will have to read carefully between the lines.

Adam Tsai and colleagues give a very thorough description of how Kaiser Permanente invests in delivering obesity care in the most positive terms possible. They describe a “whole systems” approach to obesity at Kaiser that starts at the community level, investing $50 million in healthy eating and active living programs in an effort to reduce the impact of obesity that is straining their systems for delivering healthcare.

As a key learning from these community health initiatives the authors cite the importance of delivering an adequate “dose” of an intervention to achieve an effect. They do not, however, cite evidence that they have found the right dose to deliver a change in health outcomes. The effort is noble, but it might be guided by conviction more than evidence.

In the realm of evidence-based interventions, Tsai describes an impressive investment in high-intensity lifestyle programs and medically supervised diets. The commitment to these interventions is truly systematic.

At the other end of the spectrum, the authors describe system-wide access to bariatric surgery.

But in the middle, one comes away with the impression of a significant gap. For many patients, lifestyle modification is not adequate and surgery seems undesirable. Yet coverage for intensive medical management of obesity, using FDA approved pharmacotherapy, is hardly systematic. Only two of seven regions will reimburse patients for obesity medications and only if their physicians certify that it is medically necessary.

Tsai cites misperceptions about the biological basis of obesity, misunderstandings about obesity drugs, and a conviction that obesity “should not require pharmacotherapy” as reasons for the low utilization of obesity medications.

Kaiser is a unique healthcare delivery system, sometimes described as a model for high-quality healthcare. Yet the problems that interfere with delivering a high standard of obesity care are not so different from the problems seen in other parts of the healthcare system.

Delivering systematic obesity care remains a challenge. A long tradition of systematically excluding obesity from medical care stands in the way. The bias against caring for people with obesity is a luxury that has become unaffordable.

Leaving obesity untreated has created a crushing burden of chronic diseases that result from obesity.

Click here for the paper in Current Obesity Reports. Click here for perspective on “systemness” in healthcare delivery.

Gears, photograph © Daniel Oines / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

July 16, 2016