Meeting the Challenge of Scale for Obesity Care

It’s a thought bubble that looms over many conversations about obesity. A hundred million Americans have it. Therefore, we can’t possibly respond on an adequate scale with treatment. All too often, that thought is enough. Conversations about obesity care stop before they really get started. But a new study published in Obesity today points to a different path for the conversation.

A Model of Adequate Scale

Sharyn Lymer and colleagues applied a microsimulation model for an alternative to having GPs provide basic obesity care. The scalable alternative they used was Weight Watchers. But, really, that brand is relevant only as an example. The real point is to examine the cost effectiveness of an intensive behavioral program that doesn’t rely on physicians to deliver behavior change at scale.

You see, sustained change doesn’t come from occasional advice to lose weight. One of our readers recently labeled that approach aptly. It’s the “lose a hundred pounds and call me in the morning” strategy. Nope. That doesn’t work. Effective changes come from sustained and frequent coaching. Roughly 12-26 sessions a year. For doing this, physicians are not cost effective. Their time is more valuable for other tasks. And Lymer’s model bore this out.

Modeling showed that physician referrals to Weight Watchers could prevent 60,500 cases of obesity in Australia. Even with the government health plan paying for it, health costs would go down by $17 million.

A Different Path

Absent this kind of data, we typically hear a knee-jerk reaction to discussions about delivering more obesity care. “Prevention is the only way forward,” say many policy analysts without stopping to think. Of course, with most of the population already affected, prevention alone will not move the needle. Thus, effective interventions with sufficient scale to have an impact across the population will be a key ingredient for reducing obesity’s public health impact.

But the Lymer study illustrates a different path with solid numbers.

Writing in a companion commentary, Scott Kahan and Ted Kyle conclude that it shows weight management can be cost effective when delivered at scale. And, of course, many alternatives are available. YMCA offers the Diabetes Prevention Program. The Counterweight program is having success in the UK.

The options are many. It’s time to scale up and make a serious difference.

Click here for the Lymer study and here for the commentary by Kahan and Kyle.

Massive Fires, photograph © Rob Packer / flickr

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Month dd, 2018