Recent reports and actions by state and national government indicate doctors, insurers and employers will play a large role in combating the nation’s obesity epidemic.
At a routine doctor visit you usually know what to expect. The doctor or nurse will take your height, your blood pressure, listen to your heart, weigh you - and increasingly calculate your BMI.
Body Mass Index, the standard, yet not always accurate, measurement of body fat, can let a person know if they are overweight or obese.
BMI results can be the first step in reducing many health risks, and with the rising cost of obesity, employers, insurers and many doctors want their patients and employees to know their BMI.
This year the state of Kansas offered an incentive to employees on the state health plan who reported BMI and other health factors.
At one of many HealthQuest screenings done across the state, Trudy Smits gets her blood taken to screen cholesterol and triglyceride levels
As well as her blood pressure, weight, height, and waist circumference.
Smits, a senior program manager in continuing education at KU Medical Center in Kansas City, says she participated in the biometric screening last year just because she wanted to know her risk level, and that she returned this year in part because of the 480 dollar premium reduction.
Kansas jumped on board with the plan after improved health, productivity, overall risk and savings were reported in states with similar programs.
State incentive programs; along with last year’s announcement that Medicare will cover obesity screening and counseling for seniors show a turn toward prevention. Dr. James Early, Clinical Associate Professor of Medicine at KU School of Medicine in Wichita says the trend will likely grow.
“Even the affordable care act puts a lot of cost onto payers such as business and industry,” says Early. “They are tired of spending a huge part of their bottom line on health care…we don’t want to pay these premiums anymore, we want healthier workforce with less illness and less cost.”
Early says because insurance has become so costly that even cost sharing with employees has become prohibitive, business and industry are beginning to look at insurers and doctors and ask why they can’t do a better job of keeping people well.
“Medicine has really not been tightly held to outcomes, and I often hear us say, well I can’t help what the patient does, I tell him what to do, I can’t help if they don’t do it,” says Early.
“And, that is only partly true. You know, people tend to do what they are good at and people would be much better at preventive health if we were much better at encouraging it, if we incentivized it, if we spoke in a language that encouraged it, if we partnered with out patients rather than preaching at our patients,” says Early.
“Much as my dentist has done over the years in reemphasizing brushing and flossing. Never getting angry, but how often do you do this? It looks like from your exam that we can do better on those back teeth. I mean, this constant consistent message about what you can do to take care of your teeth. We haven’t practiced that very well in medicine.”
And that, says Early, is because most medical doctors aren’t trained that way.
Preventive medicine plays a small role in most medical school curriculum, doctors aren’t trained to counsel obese patients, and under current payment structures they don’t have a lot of time to spend in conversation.
Dr. Doug Bradham is a professor of health economics at the KU School of Medcine Wichita. In collaboration with state legislators and the Kansas Department of Health and Environment, Bradham last year updated the cost of obesity to the state’s Medicaid program.
He says that while interventions by the state through changes to Medicaid and the State Employee’s Health Plan are important, the fight against obesity must move beyond the medical realm.
“What I am trying to send up the flag pole is a signal that says, that is good and those are helpful interventions,” says Bradham. “But those are probably extremely limited in their potential impact. If Medicaid is paying for 20 percent of total cost of obesity in Kansas, to make an adjustment there you are only going to have 20 percent of an impact.”
Bradham says private employers need to look beyond their health plans and look at how they are organizing things in their work environment.
“For instance is the coke machine further away than the water machine? That would make a huge difference in the amount of Coke or Pepsi that is consumed in the workplace,” says Bradham.
“Or alternatively, is the salad bar the first thing you see in the cafeteria?”
Both Bradham and Early say better methodologies and algorithms in and outside health care are needed to establish data sets and evidence backed programs that can drive change in the doctor’s office, in the work place and in the home.
“It is not a simple problem, it is not a simple solution,” says Bradham. “It is a complex thing. We’ve just simply got to stop thinking about obesity as a quick fix. There is no simple pill, there is no simple vaccine.”
A multifaceted approach is what is outlined in a report out this month from the Institute of Medicine. In addition to activating employers and health professionals in the fight against obesity, the report calls for changes in our physical environment, increased access to healthy foods, marketing campaigns, and integrating obesity prevention into schools.
Certainly not a simple solution.