Family physicians and the patient-centered medical home can play important roles in combating the nation's obesity epidemic, said U.S. Surgeon General and family physician Regina Benjamin, M.D., M.B.A., during a Jan. 28 press event at which she and HHS Secretary Kathleen Sebelius were joined by first lady Michelle Obama to kick off a campaign to reduce overweight and obesity among U.S. adults and children.
The news conference coincided with Benjamin's first release to the nation, The Surgeon General's Vision for a Healthy and Fit Nation 2010(www.surgeongeneral.gov), in which she highlights the growing numbers of overweight and obese Americans; outlines the causes and health consequences of obesity; and offers steps that consumers, parents, schools, communities and physicians can take to reverse this trend.
In her comments during the news conference, which was held at a YMCA facility in Alexandria, Va., Obama lauded the release of the document, calling it timely and "right on point."
"The surge in obesity in this country is nothing short of a public health crisis, and it's threatening our children, it's threatening our families, and, more importantly, it's threatening the future of our nation," Obama said(www.whitehouse.gov). "In fact, the health consequences are so severe that medical experts have warned that our children could be on track to live shorter lives than their parents. The paper released today is an incredibly important step in directing the nation's attention to solving the obesity epidemic, and we do not have a moment to waste."
In her comments, Sebelius noted that obesity costs the United States $150 million a year, more than every type of cancer combined. And, according to Benjamin, two-thirds of American adults and one-third of U.S. children are overweight or obese.
During the news conference, Benjamin spoke of how she was able to educate patients in her Bayou La Batre, Ala., practice about how obesity contributes to other chronic diseases, including heart disease and diabetes. Establishing long-term, trust-based relationships with patients is key to this process.
"The medical home is a place where patients feel comfortable and feel safe to talk about things and to learn," she said. "That concept will fit into this overall campaign."
In her report, Benjamin said physicians should make it a priority to teach patients about the importance of achieving and maintaining a healthy body weight, becoming physically active, eating healthy foods and managing stress. Furthermore, physicians should provide resources to help patients make healthy choices, including in-office access or referrals to registered dietitians, health educators, counselors, psychologists and fitness professionals, as well as linking them to community resources.
The surgeon general's report also calls for physicians to take the following steps with their patients:
- measure body mass index, or BMI, and explain the connection between higher BMIs and increased risk for disease and disability;
- record physical activity levels and stress the importance of consistent exercise and daily physical activity;
- assess and record information about patients' dietary patterns;
- use terms that are appropriate for families and children to define healthy weight and BMI and explain how to achieve appropriate weight goals;
- work as a team to provide a comprehensive assessment and learning experience for each patient;
- ensure that patients are referred to resources that will help them meet their psychological, nutritional and physical activity needs;
- promote awareness about the connection between mental and addiction disorders and obesity; and
- for treatment of people with severe mental illness who are at risk for overweight or obesity, consider medications that are more weight-neutral.
"For many people, a physician's office is the most trusted place they come to," Benjamin said during the conference. "It is important that we work with clinicians to give them tools on how to talk to their patients and to explain things such as diets and BMIs and the results of them."
The report also calls for the health care system to support physicians in the following ways:
- encourage clinicians and their staff to practice healthy lifestyle behaviors and be role models for patients;
- use best practice guidelines to teach medical students and clinicians how to counsel patients on effective ways to achieve and maintain healthy lifestyle habits;
- promote effective prenatal counseling about maternal weight gain, breastfeeding, the relationship between obesity and diabetes, and the need to avoid alcohol, tobacco and drug use during pregnancy;
- help clinicians and their staff advocate for community strategies that improve nutrition and physical activity resources for their patients; and
- promote innovative ways that clinicians and their staff can advocate for policy changes at local, state and federal levels that will make it easier for their patients to adopt and sustain healthy habits.
The surgeon general's report does not ask physicians to shoulder the burden of stopping the obesity epidemic alone. The paper calls for improved access to healthy food choices in schools, workplaces and communities and also advocates that physical activity in schools and workplaces be increased.
"It has to be more than just what happens in a physician's office," said AAFP President Lori Heim, M.D., of Vass, N.C., who attended the Jan. 28 event. "It doesn't do much good if you help them understand that they need to exercise and eat well if the opportunity to do that isn't there. There has to be community involvement."
The fact that public health officials are attempting to tackle the obesity issue is nothing new, she said, but the Obama administration is taking a "multifaceted approach."
The first lady(www.whitehouse.gov) has announced plans to launch an initiative to fight childhood obesity in the coming weeks.
"This will not be easy, and it won't happen overnight," Obama said at the news conference. "And it won't happen simply because the first lady has made it her priority. That, in and of itself, is not going to be enough. It's going to take all of us -- parents, schools, communities -- working together for a very long time, over a sustained period of time."
Meanwhile, a working group representing the FDA, the CDC, the U.S. Department of Agriculture and the Federal Trade Commission has issued proposed standards(ftc.gov) for marketing food to children. The proposal would ban promoting to children foods that fail to meet certain nutritional guidelines.
In related news, Sebelius announced in December(www.hhs.gov) that the FDA is in the process of identifying and analyzing food packaging labels that might contain misleading nutritional information. The agency also is in the process of developing a rule that would create consistent criteria for food labels.