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27 Jun
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Obesity Checks – Big Brother or a Helping Hand?

The US Preventative Task Force has issued new guidelines for doctors for the treatment of obesity. You are obese when your Body Mass Index (BMI) is 30 or more – this is 1 in 3 Americans, so it’s a serious problem. The BMI is calculated from your weight and height and is a measure of whether or not you need to lose weight. If you are in the BMI range 25 to 30 you are considered overweight. Above that is obesity.

One of the problems with BMI is that it doesn’t work if you are super fit and carrying a lot of muscle, but if that’s you then you won’t be reading this anyway so that’s not a serious problem. Mind you, I would have thought that most people would know if they are carrying too much weight. I know when I am, and that’s true even when my BMI is in the supposedly normal range. So I sort of expect other people to be aware of when they are overweight and when they are not, but this does not seem to be the case according to this report. Apparently 50% of obese people have never had their doctors tell them they need to lose weight. “That’s just not fair to the patient,” said Dr Der-Sarkissian from the Los Angeles Medical Centre.

I don’t need a doctor to tell me when I need to lose weight, but then I’ve only ever barely been out of the normal category. So I don’t know if it’s possible to just be unaware of a serious weight problem. But it seems the Task Force thinks that getting doctors to point out the problem and then to offer solutions is the way forward. The solutions will be long-term counselling, nutritional advice, target setting and support – none of which doctors are geared up to provide.

Obesity and obesity-related diseases already cost around $147 billion a year in healthcare spending. Adoption of these recommendations would significantly increase that spending. But there’s something else that doctors can do, and that is write prescriptions. There’s a new weight loss drug about to receive FDA approval. I wonder if there’s a connection here, because the Task Force’s finding means that healthcare treatment will be available through Medicare and other health insurance schemes. Doctors can’t provide what’s really needed which is long-term encouragement and support, so will they just write a prescription? If they do then this drug’s manufacturer will be laughing all the way to the bank.

Another problem with the solution is the boundary line. You need to be clinically obese (BMI 30+) to qualify for help, so if you are just overweight, you have to pay for your own help. I wonder how many people will put on weight just so they qualify for free help?

Losing even a small amount of weight is beneficial. According to Susan Curry (member of the Task Force) “Losing 5 percent of your body weight has tremendous health benefits, and intensive behavioural counselling programs help you do that and sustain it. Your primary care provider can, we hope, help you to find evidence-based programs.” It’s that “we hope” part that’s worrying because – at the moment – they can’t.


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