Obesity 2014: Three Steps Forward

Lee Kaplan opened the Blackburn Course in Obesity Medicine yesterday with an assessment of Obesity 2014. He described a year of frustratingly slow progress, but progress nonetheless on three fronts.

  1. Better Perspective. Obesity is increasingly understood as a disease, rather than a lifestyle choice and a character flaw. He pointed to the determination by the American Medical Association that it is a chronic disease, and also the policy decision to prevent federal employee health plans from denying coverage for obesity by considering it to be a cosmetic condition. Kaplan went on to describe an ever deepening appreciation for the physiological basis of obesity — including the influence of genetics, the microbiome, and neurohormonal pathways that regulate body weight.
  2. More Treatments. Two new drug treatments for obesity are now in the market — the first in more than a decade — and two more are expected later this year. On the minus side of the ledger, uptake seems excessively slow, with many physicians remaining reluctant to use these new treatments in the care of patients with obesity.
  3. Improving Access to Care. Kaplan pointed to the policy announcement that health plans under the Federal Employee Health Benefits program may no longer exclude coverage for obesity services by designating it to be a cosmetic or lifestyle condition. He also pointed to expanding coverage of intensive behavioral counseling for obesity under Medicare and provisions of the Affordable Care Act. At the same time he noted that reimbursement levels and limitations on eligible providers remain significant barriers to actually delivering care.
  4. We can do better. Throughout his review, Kaplan described limitations to the halting progress we’re seeing. The understanding of obesity remains woefully incomplete. Treatments offer truly useful efficacy for a limited number of patients. Accessing care remains a maddening obstacle course for both patients who need it and professionals who want to deliver it.

“Progress is a nice word. But change is its motivator. And change has its enemies.” — Robert Kennedy

One Step Forward, photograph © Eric Brochu / flickr

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