Doctors are frustrated. The mission to help heal people has been compromised by fear of malpractice, insurance mandates that can often limit time spent with patients, and the limits of therapy for some diseases. Obesity is one of those diseases.
Doctors are now acknowledging that obesity is caused by several contributing factors - genetics, family history, lifestyle, marketing strategies, financial constraints, willpower, education, behavioral/emotional issues to name a few. Another big contributor to the helplessness that doctors can feel when treating obesity, is the lack of an arsenal of viable therapies and treatments. I recently explored bariatric surgery in a blog series, and indicated that a patient needs to have a BMI of 40 or 35 with co-morbidities. So obesity management if you meet those criteria involves surgery plus lifestyle counseling. For those who may not be good surgical risks or who have a BMI just below 35, obesity management can be sorely lacking.
Doctors know that the medical costs associated with obesity track at more than $147 million annually. Screening for obesity is the easy part - getting a patient to modify their lifestyle long term can be seriously challenging. And other options like medications are quite limited. In fact, the pharmaceutical industry has been challenged to develop drugs that can help patients lose weight without experiencing significant side effects from the drugs. Thus far there has been little success and pharmaceutical giants complain that the bar has been set too high for obesity treatment drugs. A recent survey found that 40% of primary care practitioners did not feel competent to prescribe a weight loss program for seriously obese patients. Only 45% of doctors queried in the same study felt they could manage medical complications after bariatric surgeries. In another study, 60% of respondents said they knew "much or very much" about lifestyle changes, and 49% said they were knowledgeable about medications available to treat obesity. That leaves a substantial number of doctors who do not feel competent. A final study summation revealed that 84.3% of the doctors interviewed felt that "bariatric surgery is the only successful strategy for helping severely obese patients to lose weight." Even so, the possible complications from weight loss surgeries concerned these physicians so much so that their final position was that bariatric surgery should still be the last resort therapy.
To date, the referral rate for bariatric surgery is still quite low. Most doctors complain about lack of time to counsel patients, lack of interest on the part of the patients for lifestyle education (required to support weight loss surgery), cynicism about success of lifestyle counseling, lack of insurance coverage for dietician referrals, and lack of support from the medical infrastructure itself to help these patients. Though the current health landscape looks bleak, there is hope that with obesity costs soaring, the healthcare industry will make obesity treatment research a priority.
Are you seeking treatment for obesity? Have you had success or disappointment and frustration? Are you willing to learn about or make lifestyle adjustments?
Published On: February 14, 2011