U.S. Surgeon General and family physician Regina Benjamin, M.D., M.B.A., has made the prevention and treatment of obesity a major part of her campaign to improve the health of America.
Within months of taking office, Benjamin issued her first report, The Surgeon General's Vision for a Healthy and Fit Nation(www.surgeongeneral.gov). In that report, Benjamin highlights the growing numbers of overweight and obese Americans and outlines the causes and health consequences of obesity. The surgeon general also offers steps consumers, parents, schools, communities and physicians can take to reverse the trend.
Before becoming surgeon general, Benjamin spent more than 20 years as the founder and CEO of Bayou la Batre Rural Health Clinic on Alabama's Gulf Coast, where she took care of more than 2,000 of Alabama's working poor. Benjamin says it was hard to leave her patients and her practice of 23 years to come to Washington to serve as the nation's 17th surgeon general. But, as Benjamin explains, she has opened a satellite office in Washington and now has 300 million Americans as her new patients.
AAFP News Now recently interviewed the surgeon general about her efforts to combat obesity and the role of family physicians and the patient-centered medical home in those efforts.
Q. Where are we as a nation in terms of addressing the obesity epidemic at this point in time?
A. I usually talk about the fact that in 2001, (former U.S. Surgeon General David) Satcher, M.D., released the first surgeon general's report. It was about obesity, and it basically set out the dangers of being obese and overweight and the dangers it had on society. We have come a long way since those nine years.
My paper, the "Surgeon General's Vision for a Healthy and Fit Nation," kind of takes it to the next level. We know that we've done a good job in telling people they need to lose weight and they need to exercise and they need to be healthier. We know that because of the amount of money that is spent on weight loss products, exercise equipment and that sort of thing. So we know that people know that. The next phase now is how do we help them accomplish their goals, because they really do need help. And what we need to do is make our society one that makes it easy for people to eat well, exercise and make the healthy choices, the easy choices and the affordable choices, which right now they are not. It is much easier to eat unhealthy. It is much easier to be inactive. So, we need to change our design of our communities, design of our everyday lives.
Q. You talked about former Surgeon General Satcher issuing the call to action. I think Surgeon General C. Everett Koop, M.D., had started talking about the dangers of obesity, and some people would say, 'Well, the surgeon generals have been talking about this for more than 20 years, but the obesity rates are still increasing.'
A. We have been talking about them for a long time, and the obesity rates now have stabilized. They are not increasing right now, but they also are not decreasing. So what I thought that we should do -- and what is in my paper -- is that we have been talking about it for a long time. But now, it is time to stop talking about the negatives -- the obesity, the illness and the negative side -- and change the national conversation to a positive one about being healthy and being fit. While that sounds subtle, it really is important for people to want to do something because they like it. They do things because they enjoy them, they can live with them. They are not doing it because it is something bad or a prescription -- 'I have to go and get on that treadmill because if I don't I will get hypertension and I will get this, I will get those bad things -- but go out and ride a bike, walk with their family. Enjoy themselves because they are having fun.
I often talk about how we used to go disco dancing. We went disco dancing because it was fun -- it was enjoyable. We didn't go because somebody said, 'You need to go and spend an hour exercising at the disco.' You want to do things you enjoy and build it into your regular routine of life and not have to think about it -- just do it and enjoy it.
Q. What role do you see for family physicians in combating the obesity epidemic?
A. Family physicians have a major role in that. We are often the most trusted source of information. Our patients trust us -- the things we tell them. We say it with authority, and they believe us and rightfully should. And so, when we talk to our patients, we will often take their weight, and we will tell them, 'You need to lose weight.' But we need to do a little bit more than just say, 'You need to lose weight.' Explain to them why -- how it is affecting their health, how it is affecting their blood pressure, their potential for chronic diseases and how it is affecting their entire family. And spend a little bit of time helping them understand the consequences, particularly when it comes to children.
Most of the time, people want to know, and they want to know more information. As family docs, we have that role. We also know that we can let our nurses and our medical assistants, our nurse practitioners, our physician assistants -- our whole team can work on this together.
Q. How about the medical home -- where does that fit into all of this?
A. The medical home fits right in because that is the place where the patient feels comfortable, and it is their medical home. It is where they can get their medical information. It is where they can ask the questions and get understanding at a level they may not have gotten before and not have to be stuck to a 10-minute office visit. With the medical home, we accomplish the whole family, the wholesomeness of it -- the entire community approach.
Q. Being a family physician yourself, how has that influenced your approach to carrying on this fight against obesity?
A. As a family physician, I see patients in my own practice, and not just in my practice. I see it everyday in society and in the community that I practice in. And I also see the consequences of it. I see what happens when you don't treat the obesity and as things continue to get out of hand. The kids that I saw and (they) start to grow up and be overweight and become adults and start to have problems. They get type 2 diabetes at early ages. I have just seen it, and so it helps me to understand what the patients are going through.
Taking a family practice approach, we include the entire family. To help children get healthier and change this trend in one generation, we are going to have to include the entire family. And that perspective is really helpful for me in this job.
Q. In talking with primary care physicians, some of them say they don't have time in many instances to counsel the patient on weight and obesity, especially since they are not compensated for this in many instances. How do you respond to that?
A. They are absolutely right. We have very busy days, and we are extremely busy. But as family docs, we always find time to do what we need to do and what we have to do for the best interests for our patients. That is where the team approach comes in, utilizing our other team members, our nurses and our PAs and our nurse practitioners and medical assistants in helping us do that.
In addition, in the health reform (legislation) that was just passed, there is a big emphasis on prevention, and hopefully, at some point, these services will be reimbursed, and primary care doctors and anyone who is providing preventive services will be compensated.