Doctors need better arsenal to fight obesity, says expert panel

Washington Physicians need better training and tools to treat overweight and obese patients more effectively, a panel of obesity experts stated during a June 20 briefing.

The Capitol Hill briefing was sponsored by Reps. Bill Cassidy, MD (R, La.), and Loretta Sanchez (D, Calif.), as well as advocacy group the Network to Overcome Obesity Now. One in three Americans is overweight or obese, with the conditions most prevalent among adults ages 46 to 64, the advocacy group said in a statement.

“Obesity is a chronic disease. It is lifelong, and we cannot cure it at this point,” said Richard Atkinson, MD, emeritus professor of medicine and nutritional sciences at the University of Wisconsin, Madison, and clinical professor of pathology at Virginia Commonwealth University.

Dr. Cassidy, whose home state of Louisiana has an obesity rate of 31%, observed that perceptions have evolved on what is a “normal” weight. “And that’s bad for health.” As an associate professor of medicine at Louisiana State University, Dr. Cassidy said the medical students with whom he consults don’t always view patients with a body mass index of 30 or higher as being overweight.

“If we don’t conquer this epidemic, we’re not going to get health care costs under control,” Dr. Cassidy said. But as others on the panel emphasized, treating obesity hasn’t been a simple task for physicians and others in health care.

Phillip Brantley, PhD, chief of behavioral medicine and director of education at Pennington Biomedical Research Center in Baton Rouge, La., said physicians often are at a loss on how to advise or treat obese patients, and that medical schools don’t always provide adequate training on obesity treatment.

“People listen to their doctor about health advice more than anybody, so you can’t do this without physicians,” Brantley said. Ask physicians about their competence and ability to deliver effective obesity treatments, however, and most will admit that they haven’t been that successful, he said.

Dr. Atkinson agreed that physicians need to be trained better on obesity. “But once they’re trained, the work in the trenches is to try to get the American people to change their diet and exercise habits. And that is going to be very difficult.”

There are multiple factors that lead to patients becoming overweight and obese, and a lot of them stem from the “obeso-genic” environment, “which limits our activity, that entices us to eat the wrong foods at every opportunity,” Brantley said.

Behavioral and biological influences also are in play, he added. “We know that people can change their behavior, even those with severe weight issues. But how long will they change? Most people change for about six to eight months, and then those old patterns come back.”

Wanli Smith, MD, PhD, assistant professor with the University of Maryland School of Pharmacy’s Dept. of Pharmaceutical Sciences, said more effort and support was needed to develop new drug therapies for obesity.

Physicians do need more tools, and some of them may be medications, Brantley said. “But just prescribing a drug isn’t going to be enough. You’re going to have to teach physicians to do other things to manage their patients.”

In addition, given that so many Americans are overweight and obese, “we can’t have two-thirds of the population on drugs. We can’t afford it,” said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest. “We need public health approaches to this,” such as changing the environment to make it easier to eat well, she said.

The American Medical Association addressed the issue at its Annual Meeting in Chicago in June, recognizing that placing taxes on beverages with added sweeteners could fight obesity if the money is used to finance consumer education campaigns and other obesity-related programs.