Doctors seen as key in fighting nation's battle of the bulge

Washington -- Physicians should tread carefully when bringing up weight loss with patients. Tact and sensitivity in broaching the subject may go a long way toward attaining the desired result -- the loss of excess pounds, a weight-loss expert says.

Try to find a good time to address the need for patients to diet, bearing in mind that most have tried and failed to lose weight and continue to labor under the stigma that obesity carries, said Keith Bachman, MD, clinical leader of Kaiser Permanente's Weight Management Initiative in Portland, Ore.

Dr. Bachman spoke at the Weight of the Nation, a Centers for Disease Control and Prevention conference held in Washington, D.C., July 27-29.

The event was the first CDC conference to focus on the obesity epidemic, and it provided a national forum for health care professionals and policymakers to discuss measures to combat this growing health threat.

During the conference, officials released a report that placed the cost of treating obesity-related diseases as high as $147 billion a year -- about 9% of all medical spending. The findings were posted online July 27 by Health Affairs (link).

Researchers found that obesity rates increased 37% between 1998 and 2006 and accounted for an 89% increase in obesity spending, or another $40 billion a year.

Medical spending on an obese person was $1,429 greater than spending on a normal-weight person, said study lead author, Eric Finkelstein, PhD, director of RTI International's public health economics program. Prescription drugs were a significant driver of costs.

"There's no question that obesity is costly," Finkelstein said. "I would argue that the only way to show real savings in health expenses in the future is through efforts to reduce obesity."

Weight control is one key to lowering the toll taken by a range of illnesses, said CDC Director Thomas Frieden, MD, MPH, who also spoke at the conference. Dr. Frieden said the average American is 23 pounds overweight.

"Obesity, and with it, diabetes, are the only major health problems that are getting worse in this country, and they are getting worse rapidly," he said.

Connecting with patients is key

In a conference session on enlisting medical systems in obesity prevention, Dr. Bachman recommended that physicians first ask if a patient would like to discuss weight loss. This allows the physician to ease into a conversation that isn't welcomed by some patients. Some cry when the subject is brought up, leaving physicians reluctant to address the issue again.

But patient engagement is critical.

"You need to be able to link people up with their health problems and individual concerns about their weight, and then help them determine what they can do about it," Dr. Bachman said.

Doctors should suggest weight-management strategies ranging from lifestyle changes to bariatric surgery, he said. Another step is to chart a patient's body mass index and weight. Electronic medical records make it easier to collect these data.

"You can't move anything unless you measure it," he said.

Urge patients to start small, perhaps by giving up the double-chocolate latte, taking a walk at lunch time or joining a weight-management program. Remind them that a weight loss of only 5% to 10% can improve health, he said.

Dr. Bachman noted that primary care physicians have the luxury of seeing patients over time, so postponing the weight discussion to an optimal point of patient readiness and building on even a small start can lead to major changes through the years.

Physicians also can be good community role models and promoters of policies that encourage weight reduction, said Dr. Bachman, who also works with Portland schools on weight-management programs.

Dr. Frieden is another proponent of adopting policies to fight obesity. As New York City's Health commissioner, he helped institute a ban on trans fats in city restaurants and a requirement that calorie counts be posted by chain restaurants.

He would like to see a federal tax on sugar-sweetened beverages. A one-cent-per-ounce levy on soft drinks could result in a large tax windfall for the nation, as well as a reduction in the consumption of such beverages. Soft drinks may be among the largest drivers of the obesity epidemic, he said.

"Beyond the economic costs of obesity are the disability, suffering and the early deaths [obesity] causes," Dr. Frieden said. "This is something that we as a society need to take more action to address."