Reducing the Health Impact of Obesity Why Is This So Hard? Ted Kyle, RPh, MBA

Transcription

1 Reducing the Health Impact of Obesity Why Is This So Hard? Ted Kyle, RPh, MBA

2 Disclosures Professional Fees 3D Communications Eisai EnteroMedics HealthLogiX Novo Nordisk Sentara Healthcare St Luke s University Health Network The Obesity Society Research funded by the Obesity Action Coalition

3 Presentation Objectives Identify the factors that frustrate efforts to reduce the health impact of obesity Explain how bias undermines health Describe opportunities for progress

4 Why is this so hard? Cancer Is Easier to Cure than Obesity

5 Why Is This So Hard? Body Fat Is Key to Survival

6 The Body Works Hard to Protect Fat Mass One fifth of the human genome regulates energy metabolism Hunger drives food consumption In scarcity, muscles and every other organ becomes more efficient Speakman JR: Physiology DOI: /physiol

7 Why is this so hard? Because Bias Undermines Health

8 What Is Bias? Bias is an inclination or outlook to present or hold a partial perspective, often accompanied by a refusal to consider the possible merits of alternative points of view. Biases are learned implicitly within cultural contexts. People may develop biases toward or against an individual, an ethnic group, a nation, a religion, a social class, a political party, theoretical paradigms and ideologies within academic domains, or a species. Adapted from Psychology: Contemporary Perspectives Paul Okami Blind Justice, photograph by Tim Green

9 Two Kinds of Bias Are Pervasive in Obesity Weight bias directed at people with obesity Intellectual bias favoring personal convictions You! Photograph by Laura Taylor

10 Weight Bias Flows from Common Assumptions About People with Obesity Untitled, photograph by Boohoomian / flickr Photograph courtesy of the UCONN Rudd Center

11 Weight Bias Flows from Common Assumptions About People with Obesity Untitled, photograph by Boohoomian / flickr Photograph courtesy of the UCONN Rudd Center

12 Historical Bias About Obesity The best place to start is by simply telling the patient the truth. Sir or Madam, it s not OK to be obese. Obesity is bad. You are overweight because you eat too much. You also need to exercise more. Your obesity cannot be blamed on the fast food or carbonated beverage industry or on anyone or anything else. You weigh too much because you eat too much. Your health and your weight are your responsibility. Robert Doroghazi, MD AJM, Mar 2015

13 Weight Bias Makes the Obesity Worse Obesity Unhealthy Behaviors Health Impact Healthcare Avoidance Weight Bias Health Care Source: UCONN Rudd Center

14 People Living with Obesity Need Empowerment, Not Judgement

15 Why is this so hard? Opportunities for Progress

16 Untreated Obesity Harms Nearly Every Organ System Pulmonary Nonalcoholic fatty liver Gall bladder disease Gynecologic Osteoarthritis Dermatologic Gout Intracranial hypertension Stroke Cataracts Cardiovascular Diabetes Pancreatitis Cancer Phlebitis

17 Our Sick Care System Treats the Results of Obesity Heart disease Dyslipidemia Hypertension Coronary Artery Disease $444 billion Diabetes Heart attacks Strokes Kidney failure Amputations $245 billion Cancer, liver disease, and more

18 Treating Obesity? Not So Much Primary Care Physician Practices Not 74% Routinely Assessing BMI and Following Up 26% Source: Klabunde et al, , Am J Health Promotion

19 Health Plans Have Long Discouraged People from Seeking Obesity Care Routine policy exclusions for obesity Regardless of any potential health benefit Lifetime procedure caps High out of pocket costs Problematic reimbursement rates and procedures Requirements for pre-authorization

20 General Population Do you have health insurance that would pay the cost of [ ] if you needed it? Hospital Doctor BP Meds Dietitian Obesity Meds Medical Wt Mgmt Bariatric Surg Yes No 0% 10% 20% 30% 40% 50% 60% 70% 80% Note that remaining respondents were unsure of coverage.

21 Expanding Coverage of Diabetes Prevention & Obesity Care

22 Cost Benefits Driving Better Access for Behavioral Care Growing movement to expand programs following the Diabetes Prevention Program CMS actuaries found $2650 cost savings per Medicare member over 15 months

23 Metabolic Surgery Outcomes Bringing Calls for Better Access Type 2 Diabetes Remission Rates Intensive Lifestyle 0% 0% 0% Gastric Band 29% 29% 29% Gastric Bypass 40% 45% 60% 0% 10% 20% 30% 40% 50% 60% 1 year 2 years 3 years Source: Courcoulas et al, , JAMA Surg.

24 Cost Benefit Analysis Increasingly Favors Surgery UK NICE Guidelines Expedited assessment in BMI>35 with recent-onset type 2 diabetes Also assess for BMI California Technology Assessment Forum Unanimous decision favoring surgery for BMI with type 2 diabetes American Diabetes Association + 44 global organizations calling for surgery to treat type 2 diabetes and obesity

25 Evidence-Based Care Is Often Inaccessible to People with Obesity Weight Loss Scams Self-Care

26 Access to Evidence-Based Care Can Help People with Obesity Post Surgery Care Surgical Care Pharmacotherapy Professional Lifestyle Therapy Self-Care

27 What Can Employers Do? Foster a corporate culture of health Respect for diverse models of health Active work environment Access to physical activity A healthy food environment Access to evidence-based care for obesity Team in Shoe, Illustration by Frits Ahlefeldt-Laurvig

28 Genes Load the Gun Environment Pulls the Trigger Play Time Cubicles, photograph Stephen Coles / flickr

29 More Information More information: For these slides: