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Obesity — A Term that Carries a Lot of Weight. Should We Change It?

The idea of obesity is a difficult subject to broach on many levels. The term itself is loaded with stigma, and people who suffer from this condition can become resistant to even hearing the word, let alone talk about it. The shame and anticipation of judgement can be disabling, and yet the language we use when discussing weight is so limited. What can health practitioners do to break down the wall?

In a study published in a 2012 issue of the journal Obesity, researchers asked 390 obese adults in primary care settings in the Philadelphia area to complete a questionnaire about the terms that are most and least acceptable to describe excess body weight. Out of the 11 terms that were offered, “fatness” was rated as the most undesirable, followed by “excess fat,” “large size,” “obesity” and “heaviness.” (The most preferred terms were simply “weight,” “BMI,” “weight problem” or “excess weight.”)

These words encompass the majority of terminology currently used in health care to describe excess weight. But in an effort to change how physicians and patients engage with the topic of obesity, the American Association of Clinical Endocrinologists, or AACE, and the American College of Endocrinology, or ACE, have proposed a new diagnostic term to describe obesity: Adiposity-Based Chronic Disease, also known as ABCD.

“Right now, obesity is relegated to a simple construct of having a [body mass index] over 30,” says co-author Dr. Jeffrey Mechanick, a professor of medicine and medical director of the Kravis Center for Cardiovascular Health at the Icahn School of Medicine at Mount Sinai in New York City and past president of AACE. “But the word obesity doesn’t confer sufficient information about the disease risks.” ABCD on the other hand, focuses on a complications-centric approach to diagnosing, categorizing, and treating overweight.

The categorization takes into account a number of measures. In addition to BMI, this new system also takes into account the person’s waist circumference, waist-to-hip ratio, fat identified on advanced body imaging techniques such as ultrasound and MRI, and perhaps inflammatory markers on blood tests. The proposed model also includes three distinct stages:

Stage 0: The person is carrying excess weight but doesn’t have health complications from it.

Stage 1: The person is experiencing mild to moderate complications — such as prediabetes or slightly elevated blood pressure — due to excess body weight.

Stage 2: The person has more severe complications – such as type 2 diabetes or significantly high blood pressure – that are related to carrying excess weight.

What category a patient falls into would inform treatment, and would also increase the likelihood that a physician would focus on treating not just weight related complications, but also the excess body weight itself.

This new model will hopefully not only create a less biased way for physicians to engage with patients about their weight; it will also hopefully be a way for weight loss treatments to be more readily covered through insurance by having this new diagnostic term being incorporated into the medical coding structure — such as the ICD-10, or the International Classification of Diseases.

How we talk about obesity matters. And perhaps a better way to talk about obesity is to not talk about “obesity.” Not in the way people are used to hearing anyway. What are your thoughts?

Source: U.S. News

Blog written by Vanessa Ramalho/Robard Corporation


You Can’t Afford to Ignore Obesity: How Obesity Treatment Saves Time, Money and Lives

Why should a busy healthcare provider take time out of their day to treat obesity when their patients are dealing with so many other health issues? This seems to be the prevailing question among many providers, despite obesity’s 2013 designation as a disease. There are so many other diseases and ailments that need to be treated, so why obesity?

The answer: Because we can’t afford not to! And that applies to time, money and the health of your patients.

It’s true that chronic diseases suck up the majority of healthcare resources; 75 percent of all health care costs are linked to chronic conditions. People with chronic conditions are the most frequent users of health care in the U.S., and they account for 81 percent of hospital admissions; 91 percent of all prescriptions filled; and 76 percent of all physician visits. Chronic disease is widespread, and it’s only getting worse. By 2025, chronic diseases will affect an estimated 164 million Americans — nearly half (49 percent) of the population

In response to the growing concern over chronic disease, many healthcare providers and hospitals are investing thousands of dollars in resources and time to implement multi-level treatment plans targeting chronic conditions. But the question many advocates are forgetting to ask is: What is one of the most common links between many chronic conditions?

The answer: OBESITY.

Obesity is associated with significantly increased risk of more than 20 chronic diseases and health conditions that cause devastating consequences and increased mortality. Consider the following statistics:

• In the often-cited Framingham Offspring Study, obesity was responsible for 78 percent of cases of hypertension in men and 64 percent in women
• The well-known Nurses’ Health Study of more than 44,000 women found high waist circumference resulted in a two-fold increase in coronary heart disease
More than 85 percent of people who have type 2 diabetes are overweight, and more than 50 percent are obese
• Overweight and obesity are associated with increased mortality from diabetes and kidney disease, resulting in over 60,000 excess deaths per year

And this is just the tip of the iceberg. Obesity, in many cases, is the direct cause of many of the chronic conditions that we are spending so much time and money treating. Many of these conditions can be prevented, delayed, or alleviated by simply treating the cause, not just the symptoms. Research shows that modest weight loss (five to 10 percent of body weight) can reduce the risk of developing chronic conditions dramatically, and this amount of weight loss is achievable through various evidence-based medical obesity treatment models.

Not only can obesity treatment save physicians time and money by decreasing healthcare costs associated with comorbid chronic conditions, it has also been shown to be a proven revenue generating model, with real financial benefits. In a climate when we’re unsure about where we will stand with insurance and Medicare, it is imperative for healthcare providers to proactively look for new and innovative models to save time and money, and ultimately, to save lives.

Are you still asking yourself, “Why treat obesity?”

Sources: Partnership to Fight Chronic Disease, Hospitals & Health Networks, Stop Obesity Alliance

Blog written by Vanessa Ramalho/Robard Corporation


Improve Patient Outcomes: The Missing Puzzle Piece

Obesity is the fastest growing health problem in the United States. It’s also proving to be among the most deadly. It kills more Americans every year than AIDS, cancer and all accidents combined. It is the second leading cause of preventable death just below smoking. In fact, 67 percent of the population that are either overweight or obese have a greater probability of developing hypertension, high cholesterol, type 2 diabetes, heart disease and stroke. This translates to over 300,000 deaths per year from obesity related complications.1 

While the health costs of obesity are taking an enormous toll on population health, it remains underdiagnosed and undertreated. According to the American Medical Association, only 42 percent of adult obesity patients reported receiving any prior advice from a physician to lose weight.2 This is a problem. Obesity is not only a chronic disease that affects over 35 percent of adults in the U.S., but it is often the root cause or associated with over 59 comorbidities. (Read more information on comorbidities here.)

Robard has helped countless physicians from large and small group practices get started with minimal effort. For example, Dr. Michelle Haendiges of Haendiges & Associates, P.C., like many physicians, was new to obesity treatment and wanted to be sure that she could add this service without any interruption of her normal business flow. Now, she believes that obesity treatment is the most rewarding thing she’s done, that patients want real help, and that the physician is the best person to do it.  In the video below, Dr. Haendiges talks more about her story and how obesity treatment has positively influenced her practice.

Blog written by Vanessa Ramalho/Robard Corporation

1. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Executive summary. National Institutes of Health, National Heart, Lung, and Blood Institute, June 1998.
2. Pool, A. C., Kraschnewski, J. L., Cover, L. A., Lehman, E. B., Stuckey, H. L., Hwang, K. O., … Sciamanna, C. N. (2014). The Impact of Physician Weight Discussion on Weight Loss in US Adults. Obesity Research & Clinical Practice, 8(2), e131–e139.