We are not doing as well as we should with obesity in this country. It is really a sad case since the United States leads the world in healthcare spending and identification of threats to optimal health, yet we are still losing the battle of the bulge, the Obesity Epidemic.
In the United States of America, we have a lot of physicians and a thriving primary care culture. Many children and a good proportion of adults go to their physicians for routine check-ups everyday. Unfortunately we have become so overnourished that being overweight is the rule rather than the exception. More than one-third (34.9% or 78.6 million) of U.S. adults are obese according to this JAMA article cited by the CDC website while this self-reported obesity map is horrifying.
If our physicians knew enough about obesity, then why is it winning? Why are people not wrestling this scourge down? Knowledge is power. Power to win battles. The understanding of different cancers lead scientists to newer ways of attacking and defeating it. The same has happened in infectious diseases like Hemophilus Influenza and HIV. However, for obesity which we only came around to recognizing as a disease in 2013 (see this long American Heart Association Report if you desire or their recommendations here).
The expectation following the announcement by the American Medical Association that Obesity is a disease was that physicians would pay more attention to the condition and address it in a holistic manner with hopes of reversing the dangerous trend that we are seeing. However there are several reasons why those are tall dreams.
- You do not know what you do not know. The physicians, though well-meaning do not know enough about obesity to meaningfully battle it. Obesity is a complex condition and with the multi-system interactions that are in play, it may take more than defining it as a disease to got it under control.
- Primary care providers already have their hands full. The average family physician or pediatrician is very busy. The specialists working in hospital settings are even more squeezed for time. Reimbursements from payers including insurance companies, medicare and medicaid are not keeping up with inflation. The volume of paperwork and other requirements make it very difficult to take on a new entity.
- Patients feel offended. People feel offended when the issue of their weight comes up in discussion, even among family and friends. It is even worse if it is the physicians and other healthcare providers. Thus in an effort to keep the customer "right" and coming back, the issue of weight is avoided, while the provider manages health issues related to the excessive body fat.
- Patients and providers need a quick fix, maybe an app. Is there an app for that? Can I download something and make it go away? We now want fast solutions for problems. Obesity solutions sell if there is a "fat burn gizmo" as seen on TV. We want the magic diet that will get us ready for the beach in 3 weeks or the ready-made meals that worked for the celebrity we saw on TV. Nobody is ready for the hard work, the grunt work or the multiple office visits and accountability required for both our eating and our physical activity.
- It is big business. Yes it is big business. I will steer clear of the numerous complications associated with excessive body fat and just focus on the "ancillary industries" that have become 800-pound gorillas when it comes to excess weight and obesity. Diet fads, Packaged meals, Food blogs, Exercise programs, Fitness clubs and sports/workout equipment. The list is literally inexhaustible. Too much money is being made in the area associated with body weight, looks and diets. That is the offensive truth. There are so many "experts" in the arena that it is nauseating. Lots of deceit because they want your money.
- It is fueled by big business. Many fingers point to fast foods and soda as the main agents in the overnutrition battle. However, these behemoths have enough lobbying dollars to out-spend the likes of Google and Apple 100-times over.
Thus we should know where the real enemies are and understand that Obesity as an epidemic cannot be handled by physicians alone. The overweight adult must come to terms with the issues at stake and take a meaningful step towards saving us all from another threat to humanity. The story is getting worse as our numbers are now about 40% according to this ABC report today.
Look for a physician certified in obesity medicine (full disclosure I am a Diplomate of American Board of Obesity Medicine and now live in the Atlanta area) and have a discussion with him or her. That is one of the first steps I would recommend if you want to rescue yourself and the rest of the world from the obesity epidemic. As a second step check out this free BMI calculator before your visit to see your obesity physician.