The fight against obesity

Moderated by Tom Sabulis

It may not be fair to bring up obesity during the holidays when many of us like to indulge thankfully, and guiltlessly, in our favorite feasts. But there may be no better time to discuss it. The American Medical Association recently classified obesity as a disease, and experts say Medicare needs to cover treatments. Another columnist writes that younger people can guide their elders in keeping their weight and health under control.

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Our youth can fight obesity

By John E. Maupin Jr.

Something dramatic happened a few years back when an elementary school in DeKalb County began teaching students about nutrition, health and fitness. The children became interested in the quality of the food they were eating and in exercise. Soon, they were telling their parents what to put in their lunchboxes and dragging them to early morning fitness classes at school.

I think about this example every time someone asks me what we’re going to do about the obesity epidemic. The answer is, we must look to our youth to help us win this fight.

When children accept obesity as a norm, they’re picking up the wrong cultural signals. But it’s amazing how easy it can be to reverse that script and turn young people into leaders in the battle.

What’s happening in DeKalb County isn’t entirely new.

Children have been influencing lifestyle trends and decisions for years. But obesity researchers must learn how to use the excitement young people feel about living healthy lives as a weapon to fight chronic diseases. We must channel that enthusiasm — not just in primary schools, but in high schools, colleges and medical schools as well.

Here at the Morehouse School of Medicine (MSM), I work with the most enthusiastic, health-minded young people you’ll ever meet. They understand the urgency of preventing diseases, rather than trying to cure them in a crisis state. If we want young people to help us tackle obesity, we must support them with better medical infrastructure.

MSM is known for sending doctors into the field of primary care, which is the pillar of community health programs all over the country. Students flock here because they want to work with underserved populations. But there are obstacles and inequities that prevent us from building a robust primary care workforce.

Idealistic young doctors who go off to practice in rural areas rarely find that it is a path to wealth. Many struggle to pay off their student loans. Without a substantial income, what they give back to the school can be limited, reducing help to support the next generation of medical students looking to change the world.

According to a study in the journal Health Affairs, a cardiologist will accumulate roughly $5.2 million in “career wealth” from the time that person graduates until reaching the age of 65. Primary care physicians will accumulate less than half that sum. The U.S. government is not going to wave a wand and redress this imbalance.

So, at Morehouse, we’ve enlisted partners in the private sector to help close the gap. For years, companies like Coca-Cola have funded scholarships for Morehouse students who graduate and practice community medicine. Recently, they increased that commitment with a $1.3 million gift to provide eight students with full tuition.

I’m happy to report health care reform is starting to even out the value gap between primary and specialty care. A 2013 survey by Merritt Hawkins, a national physician search and consulting firm, showed the average net revenues that primary care physicians brought to their affiliated hospitals over the preceding 12 months was $1.6 million, compared to $1.4 million for specialists.

This is a big change from past trends, probably due to the spread of coordinated care programs.

With smart health care policies plus private-sector support for scholarships, we can capitalize on the enthusiasm young people bring to threat against obesity.

The young can teach the old – and I predict excellent lessons will be learned.

John E. Maupin Jr. is president of the Morehouse School of Medicine.

Policy changes needed to tackle obesity

By Tommy G. Thompson and Kenneth Thorpe

Medical professionals, public policy experts and scientists converged on Atlanta for Obesity Week recently for a very simple reason: The rate of obesity in the United States simply is not sustainable. Not for our country, not for our communities and certainly not for individuals.

How bad is it? In the past 30 years, the percentage of American adults who are obese has doubled, driving a sharp rise in such chronic conditions as diabetes, heart disease and hypertension.

The ramifications for health spending are significant. Annual health costs for obese individuals are more than $2,700 higher than for non-obese people. That adds up to about $190 billion every year. And many of these costs are borne by Medicare, which will spend a half-trillion dollars over the next decade on preventable hospital readmissions alone.

We cannot afford to wait until patients are on Medicare to fight obesity. We need personal solutions — and policy solutions — to get obesity under control.

First, we must take personal responsibility by eating less, eating healthier and exercising more. That is the basic formula for losing weight. We all know that. But, for a wide variety of reasons, that doesn’t work for everyone. We can lecture, cajole and plead all we like, but we still have an obesity problem. More than one in three American adults are obese, and experts say it’s only going to get worse.

That’s where the policy solution comes in. The American Medical Association recently, and rightly, classified obesity as a disease. That has sparked an important conversation about treatments and coverage of obesity under Medicare and other insurance plans.

Medicare must begin covering obesity treatments because chronic diseases are a primary driver of higher costs in the Medicare system and, as we know, obesity is a primary cause of chronic disease. As it stands now, however, Medicare is specifically prohibited from covering obesity treatments. That’s a mistake, and Congress must pass the Treat and Reduce Obesity Act, which will permit Medicare to provide the care people need — and remove costs from the system.

If Medicare begins covering obesity treatments, it will significantly reduce the long-term costs associated with obesity-related chronic diseases.

An example can be found in the Medicare prescription drug benefit. During the Medicare Part D debate, actuaries came in with astronomical costs, because they were only looking at the price per prescription and multiplying.

They were wrong.

Not only did the Part D program come in under budget because of competition, it actually reduced costs elsewhere in the Medicare system. In fact, the Medicare prescription drug program lowered hospital and nursing home bills for patients because access to affordable medicines kept patients healthier longer, and out of the more expensive hospitals and care facilities.

Instead of paying $100,000 for a hospital stay, Medicare was paying, say, $100 a month for prescription drugs. Which is the better deal?

Now, we must do the same with obesity treatments under Medicare and the health exchanges under the Affordable Care Act.

Obesity is a condition that we would be wise to cover and treat early and often, because the tidal wave of diseases that come in its wake are much more costly in dollars and lives. We simply must stop waiting for people to get sick and then spend infinitely more trying to make them well again. It’s just silly.

Covering obesity is a no-brainer. We must begin behaving rationally if we are going to come to grips with rising health costs and a population that is getting sicker.

Tommy G. Thompson is a former Wisconsin governor and U.S. Health and Human Services Secretary. Dr. Kenneth Thorpe is chairman of the Rollins School of Public Health at Emory University.

2 comments Add your comment

walter j. hill

December 1st, 2013
6:24 am

I AM VERY MUCH IN AGREEMENT WITH THE WRITERS OF ARTICLES ON OBESITY IN FRIDAY EDITION,ESPECIALLY THAT OF DR JOHN MAUPIN,HAVING BEEN AS A DENTIST FOR SO MANY YEARS AND PRESIDENT OF TWO MEDICAL SCHOOLS.I HOPE AS DR MAUPIN ,AS HE DEPARTS MOREHOUSE SCHOOL OF MEDICINE IN ANOTHER YEAR,WILL THEN PUSH FORWARD FOR THE POWERS OF THE GEORGIA LEGISLATURE ,AND DENTAL COLLEAGUES TO SEE THE NECESSITY OF THERE BEING RESTORED A SCHOOL OF DENTISTRY WITHIN THE IMMEDIATE METRO-ATLANTA AREA.”A HEALTHY MOUTH COMMITS A HEALTHY BODY”.I MUST COMMENT THAT PRESUMABLY AS A PSYCHIATRIST PERHAPS I HAVE BEEN ONLY MAKING A SOLO EFFORT TO HAVE CNN INCLUDE MENTAL HEALTH CONTINUOUS PROGRAMMING AS A “NON PROFIT” PART OF ITS AGENDA ,AS IS “ACCENT HEALTH PROGRAMMING ” IN MANY OF THE MEDICAL OFFICES. KUDOS TO DR SONJAY GUPTA.

Gator63

November 29th, 2013
1:09 pm

The first step would be to charge obese people more for their insurance the same way that smokers have to pay higher premiums. The second step would be to put a “fat” tax on burgers, fries, soda pop, doughnuts, etc. and dedicate those taxes to healthcare.