The Pink Door

Building Better Access to Care for Obesity

More and more, people are coming around to the understanding that obesity is a complex, chronic disease. Not a lifestyle choice. Even the American Heart Association has finally begun to change its implicit bias about this. Yet we’re still falling short on the important task of building better access to care for real obesity care.

By real obesity care, what we mean is something with some science behind it to show that it helps with a person’s health – ranging from behavioral support to pharmacotherapy and surgery.

Two new papers this week shed a little light on this challenge and the prospects for progress.

An RCT for WW in JAMA Network Open

The first of this pair is a randomized, controlled trial in the U.S., Canada, and the U.K. It compares outcomes from the WW weight management program to do-it-yourself approaches. It’s worth noting that DIY is the path that most people fall back on. By default, it’s what HCPs prescribe most often – “just eat less, move more, and you’ll be fine.”

Well, the data from this study tells us this glib assurance doesn’t reflect reality. After three months, less than half as many people in the DIY group (19 percent) had lost five percent of their body weight as the folks who enrolled in WW (41 percent). After a year, the gap was very similar. In the DIY group, 25 percent had lost at least five percent of their starting weight. A bit less than twice as many – 43 percent – had lost that much in the WW group.

The people in this study tended to be older and female. Their average BMI was 34 – class one obesity. The authors, including WW’s Chief Scientific Officer Gary Foster, note that the reduced burden of dietary self monitoring in the WW program might be helpful:

“This randomized clinical trial found that a commercial weight management program with reduced dietary self-monitoring produced clinically significant weight loss and may partially address the need for evidence-based approaches beyond the clinic setting.”

So Why Are We Making This Hard on People?

Writing in Health Affairs, Bill Dietz asks why our culture and thus our health systems are making it so hard for people to get access to treatment for obesity that works. He describes the fascination in popular culture for demeaning rather than helping people living with obesity:

“Recent [television] shows have replaced personal trainers with professional-seeming medical providers, but their tactics are much the same: publicly admonishing and demeaning patients facing life threatening medical complications. Worse still, many of these patients are also experiencing abject poverty and participate in these television shows in exchange for access to free treatment.

“This form of television entertainment would never be considered acceptable if it were depicting the treatment of any other chronic disease, but society is so determined to punish those with obesity that it has become hit entertainment.”

But he sees reason for encouragement in the recent move to open up health insurance plans for federal employees with better access to obesity care, including obesity medicines:

“We have never been closer to seeing such a large workforce gain access to this level of comprehensive care.”

So progress is coming in a very patchy way, but it’s coming. Old and frankly ignorant approaches to dealing with obesity will fade away because they simply don’t work. Bit by bit, we are building better access to better care for obesity.

Click here for the new study in JAMA Network Open and here for the commentary by Dietz.

The Pink Door, painting by Georges Valmier / WikiArt

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August 19, 2022