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Why Paula Deen and Pharma Are Ahead of Physicians on Diabetes

Posted Aug 16 2012 2:09pm

There are many groups trying to get doctors to speak with patients about their weight. I have a new approach to this, targeted for men (and the women who care for them), I’d like to talk about at SXSW:

For the first time in a long time, pharmaceutical companies and organized medicine are interested too.  Their approaches are different, and like any good communicators, they try to meet their audiences wherever they’re starting. Pharma is especially on the ball.

After taking heat for giving Paula Deen a reported $3m for taking and then promo-ing a diabetes drug, Novo Nordisk has imagined and crafted an accessible if conventional site , a national tour, a series of (good looking) recipes and charming accents, plus several familiar faces to get diabetics and pre-diabetics on the right track. It’s well-put together. But is it really helpful to people with diabetes?

The re-named American Dietetic Association (now DCE) sponsors this site, as does Novo Nordisk (and Victoza, a very good medicine that Paula is apparently taking).

I looked at the recipes: they’re generally lower carb, and higher protein, which is what you want (and not what the ADA has advocated for years). The portions are very, very small.

But if you eat just these recipes, in the amount they indicate, you will lose weight and your blood sugar will fall.

The missing link: how. How do you get from A to B. The site doesn’t offer much there, and that is what is missing in most care by most clinicians as well: they simply haven’t been well-trained in the hows, becuase so much of success and successful strategy is behavioral, environmental and personal.

Sadly, that’s true even about directives to physicians.  The Canadian Obesity Network has done a good job of outlining  ”The 5As of Obesity Management”: it is “a set of practical tools to guide primary care practitioners in obesity counseling and management:”

They are

  • Ask for permission to discuss weight and explore readiness for change
  • Assess obesity related health risk and potential “root causes” of weight gain
  • Advise on obesity risks, discuss benefits treatment options
  • Agree on realistic weight-loss expectations and on a SMART plan to achieve behavioral goals
  • Assist in addressing drivers and barriers, offer education and resources, refer to provider, and arrange follow-up

In the U.S., doctors will have to follow and document these 5 As too (I conducted a webinar about how to counsel and document CPT , and what questions to ask, earlier this year: more next year).

But though these As are well-intentioned, and get an A for effort, they get a C for clinical helpfulness.

I’ve found it highly ineffective to immediately dig into “root causes”: people want to know what to do and how to do it.  Something small, that they can be successful in.  And then they need to do something else, and repeat.   But the As…offer primarily academic steps, and a referral. Which is, in a way, back to square one.

There is a way out of this. That both pharma and organized medicine could enhance.

It is in using the patient’s own network as a coach, as a resource, as an accountability reservoir. It is in using modern technology, especially texting and mobile tech, to put the patient back in control. Roni Ziegler  has suggested that the patient is the most underutilized resource in health care, and he (and millions of patients) are right.

If you give people the tools, and teach them to use them, and act as a guide and coach in weight loss, with the right words at the right time, you will go a long way towards solving the obesity problem.  Right?

 
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