Institute of Medicine Big on BMI, Eat Less and Move More

This week, the US Institute of Medicine released an impressive 500-page thome called “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation“.

The report extensively reviews population and policy issues relevant to obesity prevention.

However, it also includes a brief chapter on obesity treatment and access in health care systems.

The following are some of the key recommendations from this section pertaining to health care:

Goal: Expand the role of health care providers, insurers, and employers in obesity prevention.

Recommendation 4: Health care and health service providers, employers, and insurers should increase the support structure for achieving better population health and obesity prevention.

Strategy 4-1: Provide standardized care and advocate for healthy community environments. All health care providers should adopt standards of practice (evidence-based or consensus guidelines) for prevention, screening, diagnosis, and treatment of overweight and obesity to help children, adolescents, and adults achieve and maintain a healthy weight, avoid obesity-related complications, and reduce the psychosocial consequences of obesity. Health care providers also should advocate, on behalf of their patients, for improved physical activity and diet opportunities in their patients’ communities.

Potential actions include

• health care providers’ standards of practice including routine screening of body mass index (BMI), counseling, and behavioral interventions for children, adolescents, and adults to improve physical activity behaviors and dietary choices;

• medical schools, nursing schools, physician assistant schools, and other relevant health professional training programs (including continuing education programs), including instruction in prevention, screening, diagnosis, and treatment of overweight and obesity in children, adolescents, and adults; and

• health care providers serving as role models for their patients and providing leadership for obesity prevention efforts in their communities by advocating for institutional (e.g., child care, school, and worksite), community, and state-level strategies that can improve physical activity and nutrition resources for their patients and their communities.

Strategy 4-2: Ensure coverage of, access to, and incentives for routine obesity prevention, screening, diagnosis, and treatment. Insurers (both public and private) should ensure that health insurance coverage and access provisions address obesity prevention, screening, diagnosis, and treatment.

Potential actions include

• insurers, including self-insured organizations and employers, considering the inclusion of incentives in individual and family health plans for maintaining healthy lifestyles;

• insurers considering (1) benefit designs and programs that promote obesity screening and prevention and (2) innovative approaches to reimbursing for routine screening and obesity prevention services (including preconception counseling) in clinical practice and for monitoring the performance of these services in relation to obesity prevention; and

• insurers taking full advantage of obesity-related provisions in health care reform legislation.

While all of this is well intended – it is really much of the same with little new insights for the practitioner.

As readers of these pages are well aware, if recording people’s BMIs and counselling them on eating less and moving more only worked, we’d probably have solved the obesity problem by now.

I may have missed it (have yet to work my way through all of the 500 pages) but I certainly did not see much that would actually help practitioners address and manage the ‘root causes’ of obesity – which, are not simply eating too much and not moving enough!

Nowhere do I see the authors address the importance of mental health, stress, time, genetics, medications, and countless other issues relevant for weight gain and its management. Nor do I see much on the urgent need for medications or the role for surgery. Entirely missing is a recommendation to address bias and discrimination in health care settings (this would have been my #1 recommendation for the entire document!) or in simply accommodating those with obesity so that they can even access proper health care in a professional, sensitive, and caring environment.

Like I said, I may have missed these passages – if yes, I apologise – if they are actually missing, this report is unlikely to change much in obesity management.

Lyon, France