Blurry People

Blurring the Line between Treatment and Prevention

The line between treatment and prevention is especially blurry when the subject is obesity, diabetes, and the many other diseases that result from obesity. Since 2002, we’ve had a well-documented intervention for obesity that effectively prevents progression to type 2 diabetes for people with obesity: The Diabetes Prevention Program (DPP).

Full and free access to this sort of care should be a done deal for everyone with health insurance. The Affordable Care Act mandates that health plans cover preventive services — without any copay — that are judged effective by the U.S. Preventive Services Task Force. The DPP is the model for one of those services.

Who knows why, but “the system” isn’t budging. The DPP prevents diabetes by helping people lose a little weight and keep it off. Yet many health plans persist in excluding weight management services from their benefits because that’s what they’ve always done. The logic seems to be that weight management isn’t a medical thing.

Responding to this failure, a new report in Health Affairs calls for “a new framework that extends and integrates existing chronic care and population health models and articulates the distinct and shared roles of care delivery and community systems to improve population health.”

Sounds nifty. How will this work? The authors say, “The full model remains to be implemented. We anticipate that changes in diet and physical activity will be followed by changes in the prevalence of obesity and related chronic conditions.”

Loel Solomon, a vice president for Kaiser Permanente and co-author of the Health Affairs report, explains:

We can’t treat our way out of the diabetes epidemic, and we can’t treat our way out of the obesity epidemic. Everything we know about public health and everything our doctors know about the conditions their patients live in compels us to solve the problem upstream.

Pushing responsibility for the problem upstream sounds great, but what will actually change? The new model in Health Affairs calls for evolution, equity, empowerment, engagement, integration, training, education, care delivery, community systems, and more. Perhaps you get the idea.

The bottom line comes down to this: everybody talks about obesity in the abstract. But few policymakers and providers are actually doing anything.

In a new study of practice patterns at Dartmouth Hitchcock Medical Center, most clinicians reported that they are happy to talk about obesity with their patients. Unfortunately, obesity was noted as a problem for only 27% of patients with a BMI in the range of obesity.

It will take more than a great new model to bring needed change. It will take action and it will take a reallocation of money to provide needed care for people with obesity. Goodness knows we’re already spending plenty of money after the fact, cleaning up the mess that results.

Click here to read more from Modern Healthcare, here to read the publication in Health Affairs, and here to read the study at Dartmouth.

Blurry People, photograph © Akio Takemoto / flickr

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September 13, 2015

2 Responses to “Blurring the Line between Treatment and Prevention”

  1. September 13, 2015 at 10:17 pm, Walter Medlin said:

    It will take guidelines that count Primary Care docs, but also Specialists as non-compliant (and therefore not eligible for incentive payments/bonuses) if they don’t formally code the appropriate BMI diagnosis in the medical record. This is too basic to EVER miss.

    Secondly, any related health condition treatment should be incentivized to have COMPLETE counseling about options, including referral to appropriate Medical and Surgical teams. Patient can do what they want, but doc must make either complete counseling, or refer for same. (IMHO)

    • September 14, 2015 at 5:01 am, Ted said:

      Well said, Walter.