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A push for patient-specific preventive medicine to fight obesity

Posted Aug 25 2010 1:27pm

by Thomas Dahlborg

It's no secret that Americans are getting fatter and that more Americans can expect to get sick and die from obesity-related complications, such as heart disease, stroke, and diabetes.

But while it is great news that people are universally acknowledging that obesity is a huge health issue, the current healthcare system does not position physicians (and other practitioners) to best leverage their skills, wisdom, heart and energy to help individual patients understand and address the root causes of their obesity.

In an editorial in the journal American Family Physician, Dr. George A. Bray of the Pennington Biomedical Research Center in Baton Rouge, La., says physicians should teach their patients who need to lose weight about caloric restriction, meal replacements, and pharmaceuticals.

Is it any surprise that most past and current efforts and investments to prevent and control obesity have been inadequate? Just take a look at how our workstyle limits our ability to give our patients the best care possible:

*A typical family physician does not have time to truly develop a relationship, trust and understanding with each patient, because he is required to meet specific productivity (e.g., 30 relative value units) requirements per day.

*A typical family physician does not have the time to truly assess and understand an individual patient's situation and drivers of obesity, because he is triple booked every 15 minutes.

*Fragmentation of the U.S. healthcare "system" means behavioral health is typically "turfed" or tossed aside, rather than becoming part of the patient's entire story. Yet how can a comprehensive solution be based on only a small component of the full patient's story?

Could the U.S. philosophy toward preventive care and funding also be holding us back? Wisegeek.com notes that in contrast to Eastern medicine, many doctors in the West do not practice individual preventive medicine. One reason: Insurance companies regard it as too pricey and time consuming.

How can we begin to adapt and change the entire health system to truly make a positive impact in our fight against obesity?

We could start by addressing some of the critical aspects of healing required to bring about positive change. Reimbursement should be tied extensively to health outcomes (not productivity and not only via small pay-for-performance payments that do not significantly influence physician behavior).

Time, relationship, trust, root-cause analysis in healing; cutting-edge chronic disease management; integration of physical, mental, emotional, spiritual, environmental, financial, and other aspects of an individual's life should be understood and incorporated as part of co-created healing solution plans.

We should insist on unbiased evidenced-based and patient-specific treatments, and access to this type of care should be available to all while we also ensure each patient's dignity and self esteem is maintained.

We can't wait for the system to catch up to preventive medicine's call to action. With more hospitals owning physician practices, the time is at hand for hospital and physician leaders along with other key stakeholders to collaborate, adapt and spur the change we need to address this obesity challenge. Let's get moving.

Thomas H. Dahlborg, M.S.M., is executive director of the physician practice True North Health Center , where he focuses on improving growth while ensuring access for the uninsured and the elderly. He has 21 years of experience creating competitive advantages, analyzing customer expectations, and developing and implementing focused and aligned strategic deployment plans. Formerly he served as the chief business strategy officer at Network Health, a comprehensive Medicaid health plan based in Cambridge, Mass.; and was COO of the U.S. Family Health Plan at Martin's Point Health Care in Portland, Maine.

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