Tuesday, November 17, 2009

Obesity: Are We Dealing With A Growing Addiction? Implications for Population Health Management Strategies

The Disease Management Care Blog welcomes Rose Maljanian, who is President & CEO of Strategic Health Equations, LLC. She has 25 years of health care experience and has served in senior leadership roles in managed care, specialty care management and health delivery systems

By Rose Maljanian

Today, yet another important and credible set of data from America’s Health Rankings have been released. It is telling us that obesity is on the rise and that the costs and health implications associated with it will devastate the financial viability of the US health system as we know it. The Urban Institute also recently released a report calling for more focus on obesity in developing health policy so that we can make headway on curbing this alarming trend.

In response, disease management and population health management companies, along with their contracting health plan, government and employer partners, are hard at work designing and deploying obesity programs. These are offering individualized health coaching to address the issue and in most cases providing incentives versus cost to participate. These programs have demonstrated some success, but have few resources in the way of evidence based practice (EBP)guidelines. They have yet to demonstrate definitive results such as those from the EBPs for diabetes or coronary artery disease medication management. Further, these programs and their staffs are fighting gravity when it comes to what we are calling behavior change because of the environment, social networks/norms, and the lack of serious medical attention often given to obesity.

If we are going to make serious headway, we need to abandon the notion that weight is a vanity issue or that obesity is solely a lifestyle choice that we as a society can all live with. While the evidence to support obesity as a condition of addiction is limited to nonexistent, the parallels to other addictions such as drug and alcohol are undeniable.

We now have evidence that fat cells, particularly those deposited centrally, are active metabolic (versus 'dormant') cells. These cells release chemicals that disrupt the normal hunger center in the brain and cause cravings even when a negative calorie balance does not exist. Thus, people consume larger than needed serving sizes high in fat and calories content while fully understanding that each bite puts them in further jeopardy of early disease and death. In compromised economic times, weight gain may put further stress on families due to the expense of food or need for new clothing because of size change. Their impairments can limit their ability at work or render them unable to perform certain types of work, which only further limits their economic future. Social activities which they previously enjoyed with friends, children and grandchildren may now be foregone or at least put at risk. The problem can contribute to compromising a relationship and even a marriage.

Continuing this negative behavior when it has these kinds of life consequences are a classic sign of addiction when it comes to alcohol and drugs.

Most would agree that allowing such adverse sequelae to build defies logic. Few people would say that an individual would consciously and regularly choose an extra cupcake or cheeseburger over their ability to work, achieve economic stability or success, enjoy time with their loved ones or be available and capable to help others in need.

Since today there are no magic bullets in surgeries or drugs that are suitable for the large numbers of people that need our help, through research we need to build an evidence base to support effective treatment that addresses the possibility that we are dealing with a sort of addiction of enormous magnitude in a very challenging circumstance and where abstinence from the “substance” altogether is not an option.

In the meantime, steps to address obesity as a serious medical and behavioral issue with addiction-based approaches are warranted. Providers can help by formally diagnosing the problem, providing treatment options and doing everything in their power to help people take charge, such as encouraging participation in programs that provide ongoing support. Payers can continue to advance the alignment of benefit designs to support diagnosis and treatment and incent participation in programs that achieve results. And finally, each individual must do their part to get help and help others before the already out of hand problem of obesity collapses our health care system and the economic viability of our country.

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