Jean-Marie Harle

Needed: New Primary Care Models for Obesity

The need for new primary care models for obesity is plain. A recent systematic review tells us that primary care providers see it as difficult to discuss with patients, futile, rife with stigma, and more of a social problem. Thus it’s a low priority. But thoughtful people are seeking a way forward. Two contrasting views surface in publications this week.

On one hand Kaiser Health News tells us that primary care providers need schooling to look beyond obesity. On the other hand, the Michigan Health Lab tells us that primary care needs to deliver more effective obesity care.

Rather than view these contrasting perspectives as an competing choice, taking lessons from both of them would be wise.

Looking Beyond Obesity

In her story for KHN, Laura Sausser begins and ends with the story of Melissa Boughton, who describes herself as someone who doesn’t “fit into the BMI box.”

When she had pelvic pain, her doctor focused exclusively on weight, prescribing diet and exercise to lose weight. The doctor missed an ovarian tumor until she finally ordered an ultrasound just to put Boughton’s mind at ease. Said Boughton:

“I hate that doctor for the way she treated me – like my pain was no big deal. She seemed to make a decision about me based off of a very cursory look.”

Sausser talks about the bias that providers hold against patients with obesity and the need for better training. She brings in perspective from Scott Butsch and the Obesity Medical Education Cooperative that is quite helpful.

So in the details of the article, one can find a robust perspective on getting past weight bias and providing good care for people with obesity. But still, we’re left with that headline suggesting doctors should “look past obesity.” Is that a suggestion to overlook obesity? Or rather, to get over the weight bias that compromises care? We’ll opt for the latter.

Delivering More Effective Obesity Care

The Michigan Health Lab presents an impressive call for models that deliver more effective obesity treatment in primary care. Though the article touches on the problem of stigma, the focus here is on building better systems to deliver effective obesity care. Insurance is a problem. But so are the established systems of primary care that exclude obesity care.

To overcome this, Lauren Oshman, Dina Hafez Griauzde, and their colleagues have published a roadmap for integrating obesity medicine providers into primary care systems.

Taken together, these two perspectives offer an excellent view of the path to progress on obesity in primary care settings. First, stop compounding the harm with weight bias. Then, begin integrating obesity treatment into systems of care.

Click here and here for these two reports.

Jean-Marie Harle, sculpture by Honore Daumier / WikiArt

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May 26, 2022