Chicken and Egg: Obesity Care Providers and Patients

The challenge of access to care is matching up providers with people who need and want care. We’re making progress. More obesity care providers are stepping up to provide care. But a new analysis published in Obesity describes a big mismatch between needs and resources.

This is National Obesity Care Week and the focus is access to care. So obviously, this disparity has our attention. Access to care is impossible without providers ready to deliver that care. We can’t have one without the other.

Urban/Rural Disparities

Kimberly Gudzune and colleagues analyzed data on the distribution of obesity medicine physicians. At the time of their analysis, 2,577 physicians held this certification. Now that number has grown to 3,370.

The good news is that obesity medicine is one of the fastest growing fields in medicine. But the bad news is that those providers aren’t in the areas of greatest need. That’s what Gudzune et al found.

For example, urban states – like Massachusetts and Delaware – have as much as four times as many providers per patient than rural states. Nebraska and Mississippi are at the bottom of the list. This disparity isn’t just because those states have fewer people. This analysis takes into account how many people with obesity need care. The gap is huge.

A Dearth of Pediatric Providers

Even more disturbing is the gap in pediatric obesity care providers. Only 38 percent of obesity medicine physicians care for pediatric patients. Even fewer have a primary specialty in pediatrics – only 175 of them. Consider that five million kids and teens have severe obesity.

These numbers make it almost certain that most kids with obesity receive no care for obesity. Even with severe obesity. The only thing they can expect is care for the complications of untreated obesity. And those are mounting.

Senior author Fatima Cody-Stanford explains:

Unfortunately, the training of many pediatricians tells them obesity is a lifestyle choice. It can be fixed by breastfeeding, healthy eating, and physical activity. So why get training for that?

Profound Gaps

Thus we have profound gaps in capacity to provide care for obesity. It’s partly driven by a misunderstanding of the disease. Obesity is not a lifestyle choice. It’s a problem of physiology. An unhealthy environment fuels it. Then, systematic barriers come into play. The misunderstanding of obesity means that it’s hard for obesity care providers to get paid for delivering needed care. Without good providers or coverage, patients don’t seek care. It’s a classic chicken-and-egg dilemma.

We’re catching up. More obesity care providers are coming into practice. But a big gap remains. We must do better in providing care where it’s needed. The cost of untreated obesity – both human and economic – is too great.

Click here for the Gudzune study and here for more on National Obesity Care Week.

Chicken and Egg, photograph © Jim Deane / flickr

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September 16, 2019