“War on Obesity”

Stanley Feld M.D.,FACP,MACE

It might be easier to win a “War on Obesity” than it is to win a “War on Terror”. At Least you can see the enemy in the “War on Obesity”. I suspect winning the “War on Terrorism” will cost us money after victory. The “War on Obesity” will save us money.

“Prevention is the Cure” for many chronic diseases. Prevention of disease is totally dependent of patient compliance. In other words, it is the patient’s responsibility. It is the healthcare system as well as the medical care system to provide the appropriate education so that patients can fulfill their responsibility.

I received the following comment from Fred van Beuningen. I found his comment worth the spotlight. It highlights the fact that you, the audience, are out there and thinking, as well as getting angry with the present healthcare system.

The healthcare system collapses because it treats -by and large- symptoms and people’s lifestyles leading to societal diseases fuelled by industry eager to sell us fat, sugar and additives. Another -big- idea, empower people to live a healthy life. Translate old esoteric knowledge of healthy lifestyle into practical advice and reward people for the improvement of their lifestyles: inspires and leads to less costs. Shareholders in pharma need not to worry, they can buy other stock and have children too.
Fred van Beuningen

Thank you Fred

We like ourselves better when we are free to responsible for our own well-being. A healthcare system has to be developed that allows us to have personal responsibility for our care and respect for our decision making about our care. The responsibility of society is to provide appropriate and valid information to help us make responsible decisions. Patient should have a free choice of lifestyle.

Successful personal responsibility for our health should be the goal. There could also be a dividend for maintaining our health. We should think innovatively as the auto insurance industry has with no fault insurance as well as penalty for poor driving. The original Medical Saving Accounts proposed by John Goodman were just that. It created a monetary incentive for not only our learning to maintain our health, but reaching that goal of good health. However, congress never allowed the MSA to be on a level to playing field with traditional insurance. The insurance industry was protecting its power in order to continue to make money with traditional insurance. I will discuss this in detail in the later. Over time, after the insurance industry figured out how to maintain its power and control of the money spent, our political system under the influence of the insurance industry’s vested interest discounted the value of the MSA and called it Health Saving Accounts.

Doing the right thing has taken a back seat to protecting the insurance industry’s vested interest. The result is the false hope created by the present Health Savings Account. HSAs are presently the hot insurance vehicle. HSAs create a minimal incentive for the patients. They might act as a transient deterrent to spending. Additionally, in a price opaque environment the Savings Account portion of the HSA is meaningless.

I believe it is a charade to pretend to have done something that will repair the healthcare system with HSAs. What has been done has been to create a false hope, as we have seen so many times in the past. We saw the promise of HMO’s and the promise of Manage Care evaporate because they were ill structured band aids to real Healthcare Reform. People insured with HSAs are still patients in the insurance companies’ panel and under the insurance industry control. The patients are told what is covered and what is not covered. They are not free to choice nor have monetary incentive to choose. Price is opaque and I suspect will remain opaque as long as the hospital and insurance industry can avoid Price Transparency. There is no prevention of complication of chronic disease incentives in these HSA plans. Remember, 90% of the cost of healthcare is spent on chronic disease complications. The prevention of the complications of disease is dependent on education and self responsibility.

Physicians can not prevent chronic disease or the complications of chronic disease. It is the responsibility of the patient to prevent chronic diseases and its complications. The patient has to change his lifestyle. Poor lifestyle choices lead to chronic disease and it’s complications! It is the obligation of the medical community to teach the patients how to make these changes. We have been deficient in this task, partly because education and lifestyle training and observation are time consuming and non-reimbursed.

The insurance industry and Medicare system has not recognized the value of cognitive services nor preventive services. They might be learning. However progress is very slow. My interpretation is they are not interested in figuring out that patient self determination can save a lot of money. At least they are giving lip service to the concept that “Prevention is the Cure”. They are very slow in paying for educational centers of excellence for diabetes, osteoporosis, heart disease and chronic lung disease. If they were serious about doing something, it would be done and we would be on our way.

There has not been enough media publicity about “Prevention is Cure”. Presently the American Association of Clinical Endocrinologist has a program called the Power of Prevention. Clinical Endocrinologists visit public schools and discuss the importance of diet and exercise and healthy lifestyles to prevent obesity and diabetes.

Unfortunately Fred is correct. The food insurance through the media throws much money at eating more and paying less. The patient reward is paying less for a hamburger, getting fat, and then getting diabetes. The food industry’s reward is more business. Society’s reward is higher health care cost. If the government really got behind the concept of preventing obesity, as they did cigarettes in 1959, our obese country would start to change.

A large portion of society is taking solution to the problem into its own hands. People are trying to live healthy lifestyles. Unfortunately industries with little value have been developed to service their desire under false pretense and no evidence. The megavitamin business is a 21 billion dollar a year business. There is little scientific evidence that taking megavitamins will have any impact on preventing chronic illness. Yet, the megavitamin business has grown yearly and continues to grow. Part of the reason for its growth is the mistrust developed for traditional medicine and physicians.

The latest rage is the organic food business. It is intuitive that ingesting large amounts of pesticides will kill us. It kills the bugs. Is it scientific to assume ingesting residual pesticides if any is present will kill us? It could be, but no one has proven it to date. The same argument and counter argument holds for genetically engineered food. Are we a people who make decisions on hearsay, media stories and beliefs, or on facts? Unfortunately, the media is the message, the facts be dammed.

I do not know the answer to organic foods’ value, but no one has proven any added value yet.

What seems clear is we are spending a lot of money on worthless stuff as people get heavier and heavier. We know obesity causes chronic disease. We should demand that the government declare “War on Obesity”.