Michael E. Greer, MD discusses the causes behind health professionals’ failure to treat the obesity epidemic.

By Michael E. Greer, MD

Obesity is an acknowledged epidemic in the United States and, normally, health professional rush to treat epidemics.  So why do I see so many patients who tell me their doctors refuse to help them manage their weight?

The reasons doctors won’t treat weight problems are many, and the consequences are fearful.

A twisted sense of morality is perhaps the most insidious cause of inaction. The patient’s excess weight is evidence of indulgence and surely the cure must be deprivation.  The patient is sent away with lifestyle recommendations, with no consideration of medical intervention. 

Unfortunately, numerous studies have concluded that diet and exercise have proven fairly ineffective in attaining long-term weight loss.  So doctors who prescribe those measures alone are condemning most patients to suffer the well documented health consequences of excess weight.

Granted, there is an inadequate body of research on medical interventions for overweight patients, but patients are promised some success by even the modest number of therapeutic agents now available.  Even better results are around the corner as the pace of research, discoveries and clinical experience in obesity medicine is quickening. 

Another disincentive for doctors is the professional approbation associated with prescribing appetite suppressants and other drugs that aid in weight management.   Too many doctors regard this as a dark art, and entirely avoid prescribing weight loss medications for fear of being labeled a bottom feeding, “diet pill” doctor.

Other factors are tied to money, a root of many evils in medical practice.  The American model of insurance-based healthcare funding includes two powerful disincentives to treating overweight patients. 

First, most health plans will reimburse care only for the “morbidly obese.”  So patients have to be extremely overweight before their doctors have any hope of being paid for their treatment.

A second financial disincentive is that overweight patients typically have a long list of associated health problems.  That means they may be a money-loser for doctors who receive per capita or fixed-cost compensation. 

Obese patients are also more likely to suffer costly complications, which negatively impacts the physician’s malpractice insurance rates.  Obese patients are more likely to be on Medicare or Medicaid, which many doctors reject entirely. 

Dare I point to an even more bracing reality?  That it is simply more profitable to treat the costly consequences of obesity than to address their root cause.

Finally, race could play a role.  It is a well established fact that minority patients are medically underserved.  Hispanics and African Americans also happen to have much higher rates of obesity.  So their care may doubly suffer if they are overweight.

In the face of these many disincentives, what can be done?

It is not enough to ask doctors to nobly act in their patients’ interests.  We need a national agenda at the highest levels to clear the way for medical management of weight at levels that constitute a health risk.

Patients are doing more than their share.  They spend billions each year on weight loss.  Now it’s time for doctors, insurers and health policy makers to step up to their responsibility.

Weight is a health issue, and we must no longer excuse the medical community’s failure to act on it. 


Michael E. Greer, M.D., is a Seattle physician who operates a holistic weight management clinic:
Gynecology, Natural Hormones & Herbs
Holistic Weight Loss Clinic
509 Olive Way, Suite 1349, Seattle, WA  98101
Tele: (206) 343-5985   Fax: (206) 343-2356


Co-morbidity Checklist

For patients with BMI 27 up to 30

 

Degree of Risk

Risk Factors

Present

Very high risk of mortality

Coronary heart disease

Including a history of myocardial infarction, angina pectoris (stable or unstable), coronary artery surgery, or coronary artery procedures (e.g., angioplasty)

 

Other atherosclerosis disease

Including peripheral arterial disease, abdominal aortic aneurysm, or symptomatic carotid artery disease.

 

Type 2 diabetes

Including peripheral arterial disease, abdominal aortic aneurysm, or symptomatic carotid artery disease.

 

Sleep apnea

Symptoms and signs include very loud snoring or cessation of breathing during sleep, which is often followed by a loud clearing breath, then brief awakening.

 

High risk of obesity-related disorders

 

Presence of 3 or more (circle)

 

  • Cigarette smoking

 

  • Hypertension

 

  • High-risk LDL cholesterol

 

  • Low HDL

 

  • Impaired fasting glucose

 

  • Family history of premature CHD

 

  • Age >= 45 for men, >=55 for women

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

               

Increased risk for medical conditions

Gynecological abnormalities (e.g., menorrhagia, amenorrhea)

 

 

Osteoarthritis

 

 

Gallstones

 

 

Stress incontinence

 

 

 

In overweight and obese persons weight loss is recommended to accomplish the following:

  • Lower elevated blood pressure in those with high blood pressure. 
  • Lower elevated blood glucose levels in those with type 2 diabetes.
  • Lower elevated levels of total cholesterol, LDL-cholesterol, and triglycerides, and raise low levels of HDL-cholesterol in those with dyslipidemia.

 

Source:  NIH Practical Guide
10-13-05