Search Results for "discrimination"
Does the Focus on Obesity Prevention Promote Bias and Discrimination?
While I am taking a brief break from clinics and other obligations (including daily blog posts), I will be reposting past articles, which I still believe to be relevant but may have escaped the attention of the 100s of new readers who have signed up in the past months. The following was first posted on 02/02/08 Imagine walking into an emergency room with chest pain and simply being sent away with a leaflet advising you to quit smoking. Imagine arriving at a hospital with signs of stroke and simply being referred to a lecture on reducing sodium intake. Imagine being diagnosed of colon cancer and just receiving well-meanining advise on the virtue of eating more fibre. What is fundamentally wrong with the above scenarios? The simple fact that they are confusing prevention with treatment. While giving up smoking, excessive salt and eating more fibre may be valuable in preventing heart disease, stroke and cancer, as treatments (at least in the short term) they are near to useless. Once patients present with the disease, they need treatment. This is not to say that lifestyle changes are not as important for secondary prevention – but they are rarely enough. While many may agree with the above, they seem to have a hard time applying this knowledge to obesity. While every politician, non-government organization and legions of health workers are campaigning for more efforts on preventing obesity, rarely do I hear the cry for more treatments – this is blatant discrimination! When a quarter of the population or around 11,000,000 Canadians already have the “disease” focussing all available resources solely on prevention is a joke. Not that efforts at prevention are not important – of course they are. Yet, even the most optimistic experts do not think that the current epidemic can be reversed in the forseeable future. It will take time to rebuild our cities, force people to abandon their cars, regulate our food chain, focus on calories and change our culture of overconsumption and sedentariness. Even if any of these measures worked, no one expects them to have an immediate impact on those struggling with obesity today. A 200 lb 17 year-old does not have 10 years to wait for “prevention” to kick in – he/she needs help today. Even if treatment focussed only on providing minimal obesity treatments to those who most need them, i.e. those already experiencing the complications… Read More »
Do Workplace Wellness Programs Promote Discrimination?
The obesity epidemic is costing employers. Earlier this year, The Conference Board estimated that obesity-related health problems cost US companies an estimated $45 Billion each year in medical coverage and absenteeism – more than smoking or problem drinking. Not surprisingly, employers and health care plans have long recognized the importance of promoting and perhaps even coddling employees into participating in “wellness” efforts. The idea is a no-brainer: healthier employees are more productive – a great investment for any company. But with any good idea, the devil is in the details. The legal limits and potential for well-meant wellness programs (especially when promoted by health-care plans and payers) for promoting discrimination are discussed in a recent article by Michelle Mello and Meredith Rosenthal from the Harvard School of Public Health published in the July 10 issue of the New England Journal of Medicine. In their analysis, Mello and Rosenthal focus on the impact of the nondiscriminatory provisions of the US Health Insurance Portability and Accountability Act (HIPPA) of 1996, which bars health plans and issuers of group health insurance from discriminating on the basis of a health factor. The general rule is that no person can be denied or charged more for coverage than other “similarly situated” persons because of health status, genetic history, evidence of insurability, disability, or claims experience. In this context “similarly situated” refers only to an employment-based classification, such as full-time or part-time, not on health factors. As a result of this, health plans can only opt not to provide coverage for particular health conditions, if this applies to all “similarly situated” individuals and is not based on whether or not people actually have that health condition. While HIPAA is designed to prevent health discrimination, it does allow insurers and health plans to reward members for participating in health-promotion programs (e.g. reduced premiums, payouts, etc.) as long as the reward is open to all members (irrespective of whether or not they actually have a health problem). HIPAA, however, makes it particularly difficult for plans to tie these rewards to actually achieving an individual health target – i.e. it allow rewards for participation but not success. In the rare cases that insurers do tie rewards to achieving health targets, there are important restrictions in place. In this regard, the provision that in cases where it is “unreasonably difficult” or “medically inadvisable” for a person to satisfy the health… Read More »
Does the Focus on Obesity Prevention Promote Bias and Discrimination?
Imagine walking into an emergency room with chest pain and simply being sent away with a leaflet advising you to quit smoking. Imagine arriving at a hospital with signs of stroke and simply being referred to a lecture on reducing sodium intake. Imagine being diagnosed of colon cancer and just receiving well-meanining advise on the virtue of eating more fibre. What is fundamentally wrong with the above scenarios? The simple fact that they are confusing prevention with treatment. While giving up smoking, excessive salt and eating more fibre may be valuable in preventing heart disease, stroke and cancer, as treatments (at least in the short term) they are near to useless. Once patients present with the disease, they need treatment. This is not to say that lifestyle changes are not as important for secondary prevention – but they are rarely enough. While many may agree with the above, they seem to have a hard time applying this knowledge to obesity. While every politician, non-government organization and legions of health workers are campaigning for more efforts on preventing obesity, rarely do I hear the cry for more treatments – this is blatant discrimination! When a quarter of the population or around 11,000,000 Canadians already have the “disease” focussing all available resources solely on prevention is a joke. Not that efforts at prevention are not important – of course they are. Yet, even the most optimistic experts do not think that the current epidemic can be reversed in the forseeable future. It will take time to rebuild our cities, force people to abandon their cars, regulate our food chain, focus on calories and change our culture of overconsumption and sedentariness. Even if any of these measures worked, no one expects them to have an immediate impact on those struggling with obesity today. A 200 lb 17 year-old does not have 10 years to wait for “prevention” to kick in – he/she needs help today. Even if treatment focussed only on providing minimal obesity treatments to those who most need them, i.e. those already experiencing the complications of diabetes, knee pain, sleep apnea, fatty livers, infertility – we would still need to provide obesity treatments for millions of Canadians. Ignoring their plight and focussing all resources on “prevention” is not only demeaning and in-human, it also perpetuates the wide-held notion that obesity is entirely preventable and that anyone who has obesity has obviously… Read More »
What I Noticed at Obesity Week 2023
A few weeks ago, I attended Obesity Week, the annual scientific meeting of The Obesity Society, in Dallas. As expected, there was a palpable buzz and excitement about the ever-expanding pipelines of nutrient-stimulated hormone (NuSH)-based treatments that bear the promise of dramatically changing the future clinical management of obesity. Given this promise, I noticed based on the many random conversations that I had with participants and looking around the well-filled plenary sessions, that there is a substantial increase in the number of physicians attending this meeting. Judging from the questions and the people I spoke to, most of these (often younger) colleagues appear to be actively practising obesity medicine. This increased clinical interest in obesity management amongst MDs is also evident by the numbers of docs lining up to take the American Board of Obesity Medicine (ABOM), a clear indication that this is a fast-growing field of medicine. Speaking of age, I was also delighted to see a younger cadre of obesity clinicians move up the ranks within the organization. While there were still a rather large number of presentations from the more senior obesity experts, some of whom have been around for decades, there was a noticeable presence of younger clinicians, who are clearly poised to take on the obesity challenge. This younger generation of obesity experts includes folks like Ania Jastreboff (Yale), Sean Wharton (Toronto), Scott Kahan (John Hopkins), Fatima Cody Stanford (Harvard), Sue Pedersen (Calgary) and TOS’ incoming President Jamy Ard (Wake Forest), all of whom have at least a couple of decades of working in the field ahead of them. They (and many others) represent the next generation of obesity leaders, which bodes well for the future of obesity medicine (and TOS). The fact that they will have a lot on their hands was apparent from the substantial industry presence at this meeting (there is no scalable innovation without industry!). Although the industry exhibition itself was rather modest (almost insignificant compared to what you would normally see at a diabetes or cardiology meeting), all major and many minor industry players in the field were in attendance and I had interesting meetings with most, if not all, of them. As for content besides novel treatments, there were of course plenty of presentations on other important topics including prevention policies, definitions, stigma and discrimination, adipocyte and neuroendocrine biology, mental health and a host of other topics relevant to… Read More »
What I Took Away From EASD 2023
Last week at EASD 2023 in Hamburg, the greatest buzz was clearly around incretin-based weight loss treatments and their potential metabolic benefits. In the many sessions on incretin mimetics, data were presented with the promise of weight loss of 25% and beyond, results that are only rivalled by surgical treatments. There were also several sessions that focussed on the increasingly complex biology of adipose tissue and the various obesity phenotypes that may be defined according to metabolic parameters. Does this mean that diabetes is now poised to take over the fast evolving field of obesity medicine? Not quite! Although clearly, weight-centric (rather than gluco-centric) management of type 2 diabetes is gaining in acceptance and importance, there is more to obesity medicine than lowering body weight or optimising glycemic control. For one, most people with obesity do not have diabetes and even if they do, normalising their HbA1c is often the least of their problems. Rather, their issues often revolve around chronic pain, osteoarthritis, sleep apnea, reflux disease, incontinence, fertility, and a host of other problems including the social and psychological burden of living with excess weight, all of which markedly impair their quality of life. As one may guess, none of these topics featured anywhere in the EASD plenaries – in fact I did not note a single presentation on the topic of weight bias and discrimination – probably the single most import issue to be aware of and be able to deal with when working in obesity medicine. Also, given that obesity is largely driven by ingestive behaviour and the principal mode of action of incretin-based weight-loss treatments is to markedly alter eating behaviour through its central actions on the brain, it may be surprising that short of the excellent presentation by Timo Müller on the role of GIP and GLP-1 on energy homeostasis (58th Minkowski Lecture – which unfortunately ran parallel to the the SURMOUNT-4 session), there was rather little focus on the central modulation of eating behaviour, the real reason why these treatments work to reduce weight. So, while I was happy to see the excitement at EASD around incretin-based treatments for weight management and appreciated the many excellent presentations on adipocyte biology, this is still a far cry from fully embracing the complexity and diversity of obesity medicine. Clearly, I expect that the presentations this week at Obesity Week in Dallas will paint a very different… Read More »
