AAMC Reporter: July 2008

Balancing the Scales In Obesity Prevention and Treatment

Richard H. Carmona, M.D., M.P.H., F.A.C.S. 17th Surgeon General of the United States, President of Canyon Ranch Institute, Distinguished Professor at the Mel and Enid Zuckerman College of Public Health at the University of Arizona, and Health and Wellness Chairperson for the STOP Obesity Alliance Steering Committee

In the face of a national epidemic, the next generation of physicians needs a new approach to preventing and reducing obesity.

Every generation of health professionals inherits challenges brought on by the realities of life in the United States. My generation inherited a population of smokers. At times, it seemed as though everyone smoked. Medical professionals largely disregarded the harmful consequences of smoking, and either smoked themselves or left it to their patients' own devices to quit. But now, thanks to research, education, and new treatments, we are seeing fewer smokers in this country.

Before this transformation occurred, smoking cost our country trillions of dollars in health care—and more importantly, millions of lives.

Now, the new generation of health professionals will inherit a different health care issue: obesity, the second largest preventable cause of death in the United States. Today, nearly 75 percent of our health care costs and seven of every 10 deaths can be traced to chronic conditions such as cardiovascular disease, diabetes, and cancer. Many chronic diseases could be prevented by focusing on obesity prevention and treatment.

Unfortunately, many health professionals believe that obesity is simply a matter of personal responsibility, and not one that the health care sector can help fix. This attitude closely mirrors how we treated smokers some 40 years ago when Luther Terry, one of my predecessors as surgeon general, issued the first Surgeon General's Report on the dangers of smoking. And, much as it was with smoking, a hands-off approach to combating obesity is ineffective.

It's critical that medical professionals be prepared to make a change in the way we approach obesity in America. The Strategies to Overcome and Prevent (STOP) Obesity Alliance was created to explore the obesity epidemic and to engage in the kind of fresh thinking that will be required in order to reverse it. The alliance is a collaboration of consumer, provider, business, labor, government, health insurance, and quality-of-care organizations.

The STOP Obesity Alliance identified stigma as a major barrier to overcoming obesity in America. Overweight patients may feel embarrassed, overwhelmed, or helpless about their situation, which can cause them to be less likely to seek medical attention and engage in the preventive care that all people need.

AAMC members are in a unique position to reverse this kind of thinking. But it is a bigger issue than just sensitivity training to improve bedside manner. Reversing the obesity epidemic will require innovative thinking and a transformation in how we approach the condition.

One of the key recommendations that the STOP Obesity Alliance has proposed is to redefine what we consider successful weight loss. In most instances, patients, physicians, and managed-care organizations all have different definitions of what constitutes success. Aggressive doctors drive for more weight loss, while desperate patients look to crash diets and dubious weight-loss methods that are unrealistic or just plain unhealthy.

The motivation seems to make sense, but clearly, these tactics are not working. So what if we were to shift our thinking and approach weight loss in a different way?

The STOP Obesity Alliance recommends a sustained loss of 5 percent to 10 percent of current weight as a benchmark for successful weight-loss interventions. In fact, losing 5 percent to 10 percent of current weight can lead to major health improvements, including decreasing risks for diabetes and heart disease. As physicians, that is the guidance that patients will look to us for: to cut through the clutter and the fad diets, and to establish a focus on realistic goals that are tied to improved health and wellness.

It is also important that the medical community place a premium on innovative ways to address obesity. Currently, individual treatment programs tend to look at intervention methods one at a time, such as diet, exercise, medication, or behavioral treatment. AAMC members have a real opportunity to help create and leverage best practice models that combine multiple interventions to effectively reduce obesity.

Of course, the availability of robust academic research is also a key component to accelerating best-practice models. To make lasting change, we must examine all the important factors contributing to obesity and how they interact with one another. For this reason, the STOP Obesity Alliance is calling for a broadened research agenda. For most other chronic health conditions in America, we benefit from a solid foundation of academic research. With obesity at an epidemic level, our need for a similar research basis is increasingly important.

The next generation of medical professionals will be treating more patients living with obesity. AAMC members are in a powerful position to educate current and future health professionals using a more dynamic, effective approach to overcoming their patients' weight challenges. And by bringing all facets of the health care community together— including patients, health professionals, researchers, and payers—we can develop a shared, evidence-based approach to defining successful weight loss, a new focus on innovation and best practices, and a broadened research agenda for obesity. This approach will help us take the steps we need to begin reversing this national epidemic.

You can further explore the STOP Obesity Alliance's research on obesity, as well as our policy recommendations for combating the epidemic, at www.STOPObesityAlliance.org.