About 79 million adults in the United States now suffer from obesity, a number that will stay unacceptably high unless there is a radical change in both the U.S. health care system and the environment, states an analysis published in September 2015 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 et al., which include representation from leading U.S., managed healthcare organizations such as Kaiser Permanente and Health Partners, explain that the Affordable Care Act (ACA), with its emphasis on prevention, provides support for this new paradigm. The authors also note that there will be challenges to implementing a combined 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.” (Fackelmann, 2015)
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 consume a diet that is more healthful and start 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 et al. suggest numerous policy changes to move the new paradigm for obesity from concept to concrete action. “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.” (Fackelmann, 2015)
Other policy changes include new ways of payment and reward quality of care; increased participation of hospitals, health plans and individual clinicians in supporting environmental and social norm changes that can help patients lose weight. The creation of a standardized set of guidelines that can be used to evaluate the new model and innovative approaches to teaching a disparate group of professionals to work together in new and more effective ways.
In conclusion, Dietz et al. realize the challenges to achieving their goal of the new model for obesity may be daunting. They believe that the roadblocks can be overcome with novel programs and public health leaders willing to rally for changes that call for immediate action to deal with this serious public health problem.
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Fackelmann, K. (2015, September 8). New Model for the Treatment and Prevention of Obesity in the United States. Retrieved September 10, 2015, from GW Public Health: http://publichealth.gwu.edu/content/new-model-treatment-and-prevention-obesity-united-states
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