Chicken and Egg

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

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


September 16, 2019

3 Responses to “Chicken and Egg: Obesity Care Providers and Patients”

  1. September 16, 2019 at 4:47 pm, Allen Browne said:

    Yup! Important topic.

    We need more accurate education about obesity to put prevention and treatment in realistic contexts.

  2. September 22, 2019 at 3:11 am, Nancy Horlick said:

    I am a pediatrician who does see patients with obesity. One of the issues I have faced as to why there aren’t more pediatricians certified in Obesity Medicine is because, as it is for me, the certification process is mostly geared towards adult patients. The treatments for the pediatric population differ and I have not found a certification be specific for pediatrics. I would really like to be certified, so please inform me if I am not informed.

    • September 22, 2019 at 3:49 am, Ted said:

      Nancy, yours is a good question. Part of the answer is that fewer options for pediatric patients have been well researched. But that’s not a very satisfying answer. But given that fact, my friends who are ABOM certified pediatricians tell me that they do find value in it. They would encourage you to seek out both training in the subject and the certification.