BY LESLIE CHAMPLIN
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 "Ms. Phat" (Veronica Monroe, L.V.N., of Houston) buys lunch from "Sam Wich" (FP J. Burton Banks, M.D., of Bristol, Tenn.) during a skit about obesity at the Conference on Patient Education. Role-playing produced insight into patient perspectives during doctor-patient exchanges. The participants also learned how to implement similar training to improve colleagues' communication with patients. |
America, supersized, will produce budget deficits, supersized. Worse, as obese Americans age, the nation's health care costs will explode. The financial shrapnel will gouge out not just holes but craters in health care coverage. And America's health care system will implode.
That was the scenario painted here by family physician Eduardo Sanchez, M.D., of Austin, Texas, the state's health commissioner, during the Nov. 20 - 23 Conference on Patient Education. Only strong collaboration between family physicians and public health agencies can avert disaster, he told patient educators at the meeting co-sponsored by the Society of Teachers of Family Medicine and the AAFP.
"By 2040, the cost of medical care associated with obesity, superimposed on the cost of care to the elderly, is going to break the system," said Sanchez. "You are going to be challenged with trying to take care of the elderly at the same time you're trying to care for the 40-year-old who has hypertension, diabetes and hyperuremia. Supersized burgers and supersized fries are the new weapons of mass destruction. We have more to fear from Big Macs than from anthrax."
True. According to the CDC, more than 61 percent of adults are overweight or obese; between 1980 and 1999, the prevalence of overweight adults grew from 33 percent to 35 percent and of obese adults grew from 15 percent to 27 percent. Research in the Nov. 10 Archives of Internal Medicine confirmed earlier studies tying excess weight in middle age to poorer health later in life.
Moreover, about 15 percent of 6- to 19-year-olds were overweight in 2000, says the CDC. Many already have risk factors for cardiovascular disease, according to Joanne Harrell, Ph.D., director of the Center for Research on Chronic Illness at the University of North Carolina at Chapel Hill.
Speaking at the American Heart Association Scientific Sessions Nov. 9 in Orlando, Fla., Harrell said about one in eight schoolchildren had three or more risk factors for metabolic syndrome, which heralds cardiovascular disease. She listed these risk factors: hypertension, elevated triglycerides, low levels of high-density lipoprotein, glucose intolerance, elevated insulin levels and excess body weight.
America can reverse its rush toward obesity, said Sanchez. He called for a new health care model that would intertwine medical expertise with public health agency school- and work-based programs. Physician advice motivates patients to lose weight. But prescriptions for weight control must include public health programs to help implement the treatment plan, he said.
 Eduardo Sanchez, M.D., calls for close collaboration between primary care physicians and public health agencies. |
"That motivation must be coupled with something else that continues to remind us about our goals until the next visit with the doctor," said Sanchez. "Physicians can't afford to see obese patients weekly, but patients often need it."
Such collaboration requires physician knowledge about the public health system. Clinicians should know health departments' telephone numbers and Web sites.
Without such collaboration, America faces a dim future, Sanchez warned.
"The physical health of America will determine its fiscal health," he said. "If we don't do something about obesity in tandem with public health, we won't have the resources it will take to take care of people. Sooner or later, we're going to jeopardize more than the health of our population. We're going to jeopardize the financial support for the safety net and social structures we've built to take care of ourselves."
Sanchez's call for aggressive intervention for overweight and obese patients came just days before the U.S. Preventive Services Task Force issued its guidelines, "Screening for Obesity in Adults: Recommendations and Rationale."
"It is advisable to refer obese patients to programs that offer intensive counseling and behavioral interventions for optimal weight loss," the USPSTF said. It defined intensive interventions as more than one person-to-person session per month for three months.
Though the USPSTF guidelines focused on adults, Sanchez also urged physicians to address weight problems among children.
Health care professionals often express concern "that we would stigmatize children by calling them obese," said Sanchez. " But any child who has a body mass index above the 95th percentile probably deserves at least a blood pressure check, a serum insulin, a lipid profile and a family history. And if these are abnormal, we need to move that child beyond the universal wellness intervention and into an intensive program."
Sanchez said America's health care system could do that if physicians worked closely with health departments. Together, they could encourage school districts to incorporate physical and dietary education into the curriculum, exercise activities into the school day, and healthy food selections into the cafeteria meals.
"We need a new model," said Sanchez. "It should be school-based, where the kids spend 90 percent of their day. It should be child-centered and family-focused. It should have continuous monitoring, and we should incentivize any model to involve family physicians."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
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