Hygeia

Where Can People Get Access to Real Obesity Care?

Ten years ago, the American Board of Obesity Medicine was not yet certifying physicians in this specialty. Today, obesity medicine is one of the fastest growing medical specialties in the U.S. A total of 5,242 physicians hold this certification. This is indeed good. But the bad news is that it is far from adequate. That is because a new analysis tells us that the number of patients with severe obesity far outstrips the capacity of these providers to provide access to real obesity care.

Less than nine percent of the clinics have adequate capacity to care for the number of patients in their communities with severe obesity. For people with any degree of obesity, the capacity is even lower. Less than two percent have adequate capacity.

Too many patients and too few providers mean that people just muddle through with mostly inadequate options for dealing with the health effects of obesity. Eat less and move more just doesn’t cut it.

Tremendous Progress

With their new study in the International Journal of Obesity, Catherine Pollack and colleagues meticulously document tremendous progress in the capacity to deliver obesity care. They explain:

“The travel time to the nearest diplomate significantly decreased between 2011 and 2019, while the number of diplomates per 100,000 mapped patients with obesity grew.”

Obesity medicine diplomates deliver better care for obesity because they’re better equipped. They can recognize the complexity of this chronic disease. They can better guide patients to receive evidence-based care.

Huge Gaps Remain

In an editorial that goes with this new analysis, Matthew Townsend, Niyoti Reddy, and Fatima Cody Stanford celebrate the progress. They also describe important progress in obesity care certification for advanced practice nurse practitioners and physician assistants.

But they note that big gaps remain. Health plans can get away with limited coverage for this care because of internalized and implicit bias. Patients don’t stand up for themselves when they don’t feel worthy. Advocates and allies are less abundant than we find for other conditions because of weight stigma.

So, many patients have to pay out of pocket or, more often, simply forego care. With such poor funding for obesity care, providing care in a rural setting is often financially unsustainable. The result is a big problem with geographic equity – as Pollack has shown us. Townsend et al call for professional societies to step up:

“Professional organizations are key stakeholders to address racial, ethnic, and socioeconomic disparities in the prevalence and treatment of obesity. Targeted outreach to communities most affected by obesity and efforts to build diverse representation within membership of obesity professional associations help us deliver equitable care.”

Follow the Money

Where can people get access to real obesity care? Where there is wealth to pay for it. Elsewhere, care gets deferred and costly complications pile up. So healthcare dollars wind up paying for preventable cases of diabetes, heart disease, liver disease, cancer, and even severe cases of COVID.

Obesity is the chronic disease where the health policy makers elect to pay a big price later for complications, rather than providing equitable access to care up front. It is a costly and inhumane mistake.

Click here for the Pollack analysis and here for the Townsend editorial.

Hygeia, painting by Gustav Klimt / WikiArt

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January 8, 2022

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