WASHINGTON, DC (September 8, 2015)--About 79 million adults in the United States now suffer from obesity, a number that will stay unacceptably high unless there is radical change in both the U.S. health care system and the environment, says an analysis published today in the September issue of Health Affairs.
"This public health crisis calls for a transformation in the way we handle obesity, a chronic disorder that is fueling high rates of diabetes, heart disease and cancer in the United States," says lead author William H. Dietz, MD, PhD, director of the Sumner M. Redstone Global Center for Prevention and Wellness at Milken Institute School of Public Health at the George Washington University. "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."
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.
Dietz and his colleagues suggest a number of policy changes that might help move the new model for obesity from the drawing board to implementation. On the clinical side they suggest that the training for health professionals must include behavior change strategies and up to date information about new ways to treat obesity, which is a complex biological condition. And they also note that better integration of clinical and community services will likely require negotiations and written agreements between groups that are not used to working together.
Other policy changes that must be addressed include new payment mechanisms that reward quality of care; an expanded role of hospitals, health plans and individual clinicians in supporting environmental and social norm changes that can help patients lose weight; a standardized set of metrics that can be used to judge the new model and novel approaches to training a diverse group of professionals to collaborate in new and more effective ways.
Finally, the authors note that challenges to implementing the new model for obesity will be substantial. However, they believe that obstacles can be overcome with the help of innovative programs; new mechanisms and policies that support the radical new framework; and finally public health leaders willing to push for changes that are urgently needed to combat this serious public health problem.
The paper, "An Integrated Framework for the Prevention and Treatment of Obesity and Its Related Chronic Diseases," appears in the September issue of Health Affairs. Dietz and his co-authors are all members of the Integrated Clinical and Community Systems for the Prevention and Management of Obesity Innovation Collaborative of the Institute of Medicine's Roundtable on Obesity Solutions.
About Milken Institute School of Public Health at the George Washington University: Established in July 1997 as the School of Public Health and Health Services, Milken Institute School of Public Health is the only school of public health in the nation's capital. Today, more than 1,700 students from almost every U.S. state and 39 countries pursue undergraduate, graduate and doctoral-level degrees in public health. The school also offers an online Master of Public Health, MPH@GW, and an online Executive Master of Health Administration, MHA@GW, which allow students to pursue their degree from anywhere in the world.