Obesity is a health epidemic that impacts around 79 million Americans. Obesity is now viewed as a chronic disorder, a classification that acknowledges that once a person becomes obese, they usually remain obese for their entire lifespan.
The situation is dire as obesity often leads to high rates of diabetes, heart disease, and cancer fueling poor health and expensive medical care. Experts believe the number of obese Americans will remain unacceptably high unless there is radical change in both the U.S. health care system and the environment.
As such, public health researchers call for a revolutionary new approach to prevent and treat obesity.
“We propose a new model for the prevention and treatment of obesity, one that integrates health care in the clinic with resources in the community that make it easier for people to prevent unhealthy weight gain or lose weight and keep it off,” said lead author William H. Dietz, M.D., Ph.D., director of the Sumner M. Redstone Global Center for Prevention and Wellness at Milken Institute School of Public Health at the George Washington University.
Dietz and his co-authors, including representatives from leading U.S. managed care organizations such as Kaiser Permanente and HealthPartners, point out that the Affordable Care Act (ACA), with its focus on prevention, provides support for this new model.
At the same time, the authors note that there will be challenges to implement an integrated framework, including the need for incentives so that health care systems go beyond the clinic doors to link up with resources for fighting obesity in the neighborhoods where people actually live.
Community resources include safe places for people to exercise and stores or farmers markets where they can purchase healthy foods.
The new model proposed by Dietz and his colleagues includes:
- A system that is centered on individual patients and family engagement. The authors note that successful models of obesity treatment often require behavioral changes such as preparing nutritious foods or increasing physical activity — and families play a key role in these efforts;
- Restructured clinical services by providers who are sensitive to the stigmatization of people with obesity. Doctors and other health professionals also need to learn behavioral strategies that can motivate patients to change their diet and get started on an exercise routine;
- Better integration between clinical services and community systems that can make it easier for patients to lose or maintain their weight. For example, partnerships between the clinic and the YMCA or other community-based resources can often provide patients with a structured way to get regular exercise or nutrition counseling.
Successful implementation of the model, however, will require significant changes in both clinical care and health care reimbursement models.
For example, Dietz and his colleagues believe that clinical training for health professionals must include behavior change strategies and up to date information about new ways to treat obesity, a complex biological condition.
They also call for better integration of clinical and community services — a relationship that will likely require negotiations and written agreements between groups that are not used to working together.
Other policy changes that must be addressed include an expanded role of hospitals, health plans and individual clinicians in supporting environmental and social norm changes that can help patients lose weight.
Further, researchers call for a standardized set of metrics that can be used to judge the new model and gauge novel approaches to training a diverse group of professionals to collaborate in new and more effective ways. Finally, a payment approach that rewards values and outcomes is necessary.
Although the challenges to implementing the new model for obesity are substantial, study authors believe the obstacles can be overcome with the help of innovative programs, mechanisms, and policies that support the radical new framework.
Source: George Washington University