Miners’ Wives Carrying Sacks of Coal

Health Systems Hindering Health for People with Obesity

In a new cohort study, it is plain to see that, even before the advent of new GLP-1 medicines for obesity, primary care patients could get better health from obesity care. But health systems hindering delivery of obesity care make this exceedingly unlikely for most people living this disease.

A Large Cohort Study from an Academic Health System

James Henderson and colleagues published their new paper in JAMA Network Open. They conducted a retrospective cohort study of 146,949 patients in the University of Michigan health system between October 2015 and March 2020. They found that obesity prevalence grew in this population between 2017 and 2019. And they found that the utilization of any kind of obesity care in people with obesity grew – from five to seven percent of people living with obesity.

That’s right. More than 90% of people with obesity get no medical care for obesity whatsoever. None.

But they found that those lucky few who got medical care for it could expect to enjoy substantial health benefits that vary according to the kind of treatment they receive. For patients receiving only nutrition counseling, about a quarter of them enjoyed clinically significant weight loss that lasted for a year or more. For those receiving bariatric surgery, 93% did.

Senior author Dina Griauzde tells us:

“These findings suggest that all weight management treatment options can be highly effective. The challenge is helping an individual patient find a treatment that works for them and that they can stick with over time.

“Right now, health systems often make that difficult. Better systems could help us reach many more people who would benefit from obesity care.”

Health Systems Hindering Obesity Care (and Health)

The bottom line is quite simple. Our health systems – especially health insurance – are tuned to provide care for the effects of untreated obesity. Diabetes, heart disease, liver disease, cancer, joint disease, and a long list of other problems. But they carefully deny access to obesity care. It is a bitterly absurd situation which endocrinologist Jody Dushay describes starkly:

“Many patients have asked me if I can whisper sweet nothings to their insurance provider and give them an incorrect diagnosis of diabetes so they can get Ozempic. My answer: No, that is medical fraud. Some half joke that they should eat a lot of sugar so they cross the line from prediabetes to diabetes and can continue to get the medication. In what bitter health care universe do people with obesity want to get diabetes so they can access better medical care?”

This is stupid, costly, and must change.

Click here for the Henderson Paper and here for further perspective on their findings. For more from Dushay, click here.

Miners’ Wives Carrying Sacks of Coal, painting by Vincent van Gogh / WikiArt

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March 1, 2024

2 Responses to “Health Systems Hindering Health for People with Obesity”

  1. March 01, 2024 at 7:06 am, Michael Jones said:

    Indeed, it is a rather sick and twisted sensation when I find myself celebrating with a patient who has finally hidden A1c of 6.5.

  2. March 01, 2024 at 9:29 am, Allen Browne said: