The Biggest Conversation We’re Not Having
It’s a problem of colossal proportions. The Centers for Disease Control and Prevention recently reported that more than two-thirds of U.S. adults are overweight or obese. The number of Americans at risk for chronic disease is not only a public health concern; it also puts a hefty burden on our nation’s health care budget. For most health care professionals, the debate is closed. Obesity must be addressed — and soon.
Despite the near unanimous agreement, Department of Health Policy researchers Christine Ferguson, J.D., and Jennifer Leonard, J.D., M.P.H., contend that the issue is being overlooked, and in a surprising place: physicians’ offices. In conjunction with the Strategies to Overcome and Prevent (STOP) Obesity Alliance, Ferguson and Leonard have exposed a serious disconnect between primary care practitioners and patients when it comes to one of the most significant health issues of our time.
What’s (Not) Happening
Last August, the STOP Obesity Alliance, which enhances awareness and identifies barriers that fail to support successful obesity management, hosted a panel discussion focusing specifically on primary care. After compiling the experts’ recommendations and completing an extensive literature review, Ferguson and Leonard released a white paper outlining their findings. As a follow-up, a national survey was commissioned to uncover more information about gaps in communication, weight monitoring, and obesity management in primary care.
“We had a sense from some of the research that there’s a real failure to communicate between doctors and patients when it comes to this issue,” says Ferguson. “And that is exactly what we saw when we did the survey.”
That disconnect begins within the first minutes of an appointment. The survey revealed that more than two in five physicians do not regularly measure height and weight, the information needed to calculate body mass index (BMI). When the measurement is taken, it doesn’t always spur a conversation: Only 39 percent of surveyed patients with a BMI of 30.0 or higher recall their physician telling them that they were obese. Further, those who were informed said that they were encouraged to lose weight. But about one in three said their physician never discussed how.
The findings are startling, particularly because a majority of physicians surveyed recognized their responsibility to help patients lose weight. So what is preventing these vital dialogues from taking place?
There is no simple solution, Ferguson explains. “There are a tremendous number of patients who believe that the conversation belongs in the doctor’s office. But on the physician side, there is an equally large number that have no idea what to tell them.” Seventy-two percent of physicians surveyed reported that no one in their practice has been trained to deal with weight issues, and effective resources are equally lacking. “There’s very little in-between [diet and exercise or surgical intervention] in terms of good tools to help primary care doctors work with their patients,” she adds.
Ferguson also notes that a stigma is still attached to obesity. “People on both sides of the equation feel that it’s a futile conversation. People have tried to lose weight and have been unsuccessful. And doctors are often uncomfortable with the discussion.” Most patients surveyed felt that weight loss is a personal responsibility — but, like physicians, they struggle for effective solutions.
Additionally, practitioners cite a lack of time during appointments to effectively discuss obesity management. “Yet,” says Dr. Richard Carmona, the 17th U.S. surgeon general and the alliance’s health and wellness chairperson, “even if they had those precious extra minutes, many [doctors] would still be missing needed information about weight-loss tools and existing programs. It’s time to close that information gap.”
Closing the Gap
That time is long overdue, which led the alliance to develop five areas for improvement. First, there must be increased efforts to consistently monitor not only BMI but also other health indicators, such as blood pressure, glucose, and cholesterol levels.
Secondly, physicians must assess and encourage patient motivation. Obesity is a complicated issue, and preparing to confront it can be challenging. But the experts urged that a lack, or perceived lack, of motivation shouldn’t deter physicians from broaching the subject. Encouraging patients to focus on a few small lifestyle changes, rather than a complete overhaul of current behaviors, can put them on the right track and redefine success, the third tenet of the alliance’s recommendations.
“This is a health care issue, not a cosmetic issue,” says Ferguson, alluding to society’s often unrealistic definitions of weight loss, such as measuring at a “normal” BMI, reaching a “goal weight,” or achieving a celebrity-esque physique. A more practical objective, and a dramatically beneficial one in terms of improving health outcomes, is losing five to 10 percent of total weight, according to the National Heart, Lung, and Blood Institute. “Establishing [this amount] as a starting point for success could result in improved weight management outcomes,” she says.
Next, the report extolled increased integration and coordination of care. “Larger, more integrated, and multispecialty practices seem to be providing a more comprehensive solution to both prevention and treatment of obesity,” because of the network of other health care specialists, such as nurses, physical therapists, and dietitians, who can play a role in weight-loss efforts, says Leonard.
Finally, the implementation of electronic medical record systems, explains Leonard, could “make a big difference because they prompt the physician to enter height and weight fields,” and also allow for better information sharing across multiple physicians.
The alliance hopes that its findings will be a wake-up call and spur real action from physicians, patients, and policymakers. “It will help physicians to understand that they need to have a proactive conversation with someone who falls in the overweight or obese category and that the conversation is one that will be welcomed by the patient,” says Ferguson. “We also hope it will lead patients to be the first to broach the topic with their physician if necessary.”
Ferguson has reason for hope: “There are some promising new technologies that might come down the pike that physicians can integrate into their practice and use effectively. We have surgical interventions, pharmaceutical interventions, and behavioral interventions, and the rate of discovery and use is accelerating.”