A big but reversible problem

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Candace Stuart, Editor

Obesity does not discriminate by age. Today’s youth and elders—and all ages between—have seen the problem expand. What will reverse the trend?

Common sense says that prevention should be the first line of defense. That means educating patients and the public at large about the benefits of proper nutrition and exercise. In late 2011, the Centers for Medicare & Medicaid Services approved obesity screening and counseling by primary care physicians, with periodic face-to-face counseling for patients with a body mass index of 30 or greater. But in practice, many patients find it difficult to meet and maintain weight reduction targets through lifestyle interventions.

In June, the American Medical Association (AMA) designated obesity as a disease in hopes of compelling payers to properly compensate physicians for obesity-related procedures and services. Studies have shown that in some cases low Medicare reimbursement for laparoscopic gastric bypass surgery may be an impediment to care, for instance. Private insurers may pose an even greater barrier.

The AMA overruled its advisory panel when it voted to classify obesity as a disease. Its Council on Science and Public Health called for better clinical and public health strategies to help obese patients modify behaviors but members voiced concerns over the potential to rely on pharmaceutical and surgical interventions rather than diet and exercise. 

Perhaps we need all of the above. A review of 52 studies found that the mean age of obese patients who underwent bariatric surgery was 42 years: young enough for potential long-term benefits but perhaps a difficult population for a strictly behavioral intervention. That approach might have a better chance of success with more malleable young adults and children.

What has worked and failed for your practice? Let us know.

Candace Stuart, Editor
Email: cstuart@trimedmedia.com
Twitter: @cstuartCVB