A comprehensive approach to diagnosing and treating obesity is just good medicine, and physicians need good reimbursement policies to make this practice practical. Fortunately, a recent ruling out from the Centers for Medicare and Medicaid Services (CMS) is one bright spot in beginning to change this trend. CMS has ruled that it will cover services for high intensity obesity counseling.

Specifically, the federal agency has said it will pay for obese Medicare beneficiaries to undergo behavior modification and weight-loss counseling in the primary care setting.  These counseling sessions could be administered outside of the context of any associated chronic conditions, such as diabetes, allowing physicians to treat the problem from its root rather than as a reaction.

The intensive behavioral therapy for obesity consists of screening for obesity in adults (using measurements of body mass index, or BMI); dietary assessment; and behavioral counseling and therapy to promote sustained weight loss through high intensity interventions concerning diet and exercise. Counseling will involve one office visit every week for a month; one office visit every other week for months two to six; and one office visit for every remaining month through one year.

Further, patients must show incremental weight loss totaling at least 6.6 lbs by the six month mark in order to complete treatment that year. While this benchmark may not seem remarkable to a culture that embraces a “Biggest Loser” mentality of weight loss, we must keep in mind that such measurable progress can make a meaningful difference in an overweight patient’s long term health, and it can reduce the risk of more than 60 related chronic conditions, including heart disease, cancer and diabetes.

Coverage For Obesity Counseling Promises Significant Benefits

Enabling more primary care practitioners to treat more patients for this $168 billion per year—and growing— epidemic is a step that may, in part, help turn the tide on the obesity epidemic in the U.S.  At present, less than half of primary care physicians report regularly providing nutrition and weight-control advice to adult patients with weight-related disease, and less than a quarter track their weight-control behaviors over time.

However, a study released last month in the New England Journal of Medicine found that obese patients lose more weight when they’re part of a primary care-based program that incorporates lifestyle coaching, plus weight loss medication or meal replacement, compared with doctor visits alone. After two years, those in an enhanced counseling group lost the most weight, about 10.1 pounds on average, than those in a group that had only brief coaching sessions and a group that underwent only quarterly visits; these groups lost about 6.4 pounds and 3.7 pounds respectively. As there is no single weight loss approach that is proven to be successful across the population, the new ruling is promising in its intent to cover multiple consultations with obese patients in order to monitor progress as well as discuss alternative treatment options.

Private Payers Should Follow Medicare’s Lead In Covering Obesity Counseling

As Medicare’s new approach is a step in the right direction, it is one that private payers may also do well to adopt. While it is important to catch and treat obesity in elder populations, Americans would be well served to do the same across the age spectrum, particularly at the youngest ages when clinicians have a real shot at making a difference throughout the private sector. As we know that overweight adolescents have a 70 percent chance of becoming overweight or obese adults, such policies would be to the benefit of patients and taxpayers alike.

Indeed, the decision presents some good news for taxpayers who have been footing the bill for the obesity epidemic. Last year, the Congressional Budget Office reported that per capita health care spending for obese adults (as of 2007) is 38 percent greater than for adults of a “normal weight” — defined as a person with a BMI between 18.5 and 25. This constitutes a more than four-fold increase in obesity-related spending over a mere twenty-year span. And according to researchers at Emory University, obesity may account for 21 percent of all health care spending by 2018.

Obesity Costs Extend Beyond The Health Care System

Further, obesity is not only costly in the health care setting. Employers alone experience a more than $73 billion loss each year due to losses in productivity, absenteeism and medical costs attributed to obesity, according to researchers at Duke University. The impact on business can total $1,000 to $6,000 in added cost per year for each obese employee, with the figure rising along with a worker’s body mass index. Additionally, costs extend to our military where more than 1,200 first-term enlistees are discharged every year because they cannot maintain a healthy weight. Beyond the staggering health concerns this presents to our young men and women, the military must also recruit and train a replacement at a cost of $50,000 for each discharged enlistee.

CMS Should Cover Obesity Treatment By Specialists

With these figures in mind, the decision presents itself as an investment in both our physical and fiscal health. However some work remains to be done. While the coverage provides payment for services provided in the primary care setting, this is not the only area in which obesity treatment services are provided.

Primary care physicians often lack the essential training in nutrition and exercise therapy to provide comprehensive treatment services for their patients. These patients may be better served by seeing not only a primary care physician, but also a specialist in an area relevant to their clinical needs,  such as a registered dietitian, exercise therapist or an obesity medicine specialist. As CMS continues to consider coverage of preventive services for obesity, an appropriate next step would be to provide coverage for these specialized services and other appropriate clinical visits for patients with obesity

Our current view is based upon delivery of a service, rather than the patient outcome— which incented more service, and therefore more cost. This crazy reimbursement structure—based upon cost creation—dates back to 1965 when Congress first established Medicare. Every healthcare provider is required to submit cost reports for payment. The providers establish their own cost for conducting a procedure, and are reimbursed at cost plus a profit margin as long as they follow Medicare regulations.

Imagine the math when there is no standard cost for the same procedure—5,000 hospitals x 5,000 different costs = 25 million different prices. The same lack of price transparency applies to pharmaceuticals and medical devices.

So, in four decades the cost of care has never abated. While government adapted some cost control measures, it really just shifted costs right into the private sector; private and public corporations and employees picking up the expensive tab.

The shift has played a very negative role on our economy. In fact, I submit it’s been largest driver of lost manufacturing jobs (six million) and the economic struggles of today’s middle class. Why? American businesses continue to offload health insurance risk to individual employees.

The need to rethink the payment structure is clear. California, Illinois and New Jersey are nearly bankrupt, and the federal government has over $14 trillion of debt. Reimbursement rates are coming down, and if healthcare providers are unable to better manage cost structure, they could quite possibly go out of business.According to the Kaiser Family Foundation, workers’ share of family health insurance premiums has increased 131 percent since 2001. 2010 alone saw an 8 percent increase in individual plan premiums and family plans are up 9 percent. At a cost growth rate of 3-3.5 times our country’s Gross Domestic Product, the worker healthcare burden is likely to grow.

Most experts agree rewarding care results is the best way to lower costs. After all, when we buy a car, we buy based on capabilities; not on delivery of the car itself. This same thinking is now being applied to healthcare.

Next year hospitals will be at risk to lose up to 2 percent of Medicare reimbursements if they deliver poor quality. Medicare has begun publishing thousands of hospital patient safety records—with details related to complications, death rates and medical errors.

The Centers for Medicare and Medicaid Services (CMS) announced this summer a pilot program to improve cost and quality of care by aligning incentives among providers. The “Bundled Payments for Care Improvement Initiative” participants will receive payments for 10 conditions for which payments would be “bundled” for episodes of care.

For example, rather than pay each provider for their specific service delivered as part of a hip replacement—the tests, surgery, rehabilitation—payment is delivered in one lump sum to all providers involved in that treatment episode. Each involved is rewarded for reducing potentially avoidable complications and penalized for excess care.

Bravo to the providers choosing to participate. To those on the sidelines, I say ‘This train has left the station.’ Commercial payors are ahead of CMS and already are using this methodology. Many providers today need to manage simultaneously fee-for-service models and various forms of value-based reimbursement.

Many of us in the healthcare industry have been preparing for what is about to occur. Several years ago our company began developing technology and services that help hospitals holistically contain costs, while delivering the best results.

Our bundled payment technology recently became the first to gain certification by the very company that created essentially the same methodology CMS will be using. The methodology enables hospitals to break out fees per episodes, contract prices at regional level, unit price per service and provider practice patterns, and adjust for severity at the patient level. It also delivers both prospective and retrospective capabilities to enable distribution of dollars in complex care delivery settings.

We built our technology from the ground-up to address the CMS delivery model. We’ve already realized success in supporting our pilot clients with value-based reimbursements. Which brings me to my second suggestion: Don’t wait to engage your clinicians in discussions to drive improved performance. The stakes are too high.

None of us have a crystal ball. We don’t know how the Supreme Court will rule, or who will occupy the White House in 2013. Regardless, healthcare reimbursement change is here to stay. For me, incentivizing our healthcare system to deliver the best patient outcomes at a lower cost per unit is a good thing…and its time has come.

Beginning medical school at the age of 16 after skipping grades in his early primary years, Bansal describes himself as a thinker and problem solver.

That’s one of the things that steered him toward internal medicine instead of surgery.

“I thought internal medicine suited me better because I like thinking through and working out problems, then trying to solve them,” Bansal said.

Treating patients 18 and older, he looks forward to establishing family relationships with patients, growing his practice to include multiple generations.

Bansal earned his medical degree at Smt. NHL Municipal Medical College in Ahmedabad, Gujarat, India. In Chicago, he studied public health, with an emphasis on insurance and policy development, an area that piqued his interest because of the direct impact it can have on patient care. He completed his internal medicine residency at the University of New Mexico in Albuquerque before moving to the Midwest in early August.

Bansal’s aunt lives in Milwaukee and he knew he also wanted to come to the United States because he admires the country’s way of practicing medicine and feels the health infrastructure of the country is beyond compare.

Now 28, Bansal said he plans to marry and have children someday, but right now he’s concentrating on his ultimate goal – to be the best doctor possible.

“There’s always a high demand for good primary care providers,” Bansal said. “I hope to help fill that need.”

“There’s such a broad spectrum of care, particularly in internal medicine. It takes constant reading and lifelong learning to keep abreast of the ever-changing medical field,” he said.

“I spend time every single day with medical journals and online – learning more,” Bansal said. “Internal medicine is so vast. Thirty years from now, I’ll still be learning.”

In general, he said, the two biggest factors that affect health are obesity and smoking.

“Weight loss is so important. Obesity affects everything from cholesterol to high blood pressure, heart disease and diabetes. And smoking plays a role in many problems, especially in connection to numerous types of cancer,” he said. “If people maintain a proper weight and stop smoking, it takes care of many common health problems.

“I personally work at staying fit because I know – as a doctor – just how important it is, and I want to set a good example for my patients of all ages,” Bansal said.

He tends to be an outdoorsy type, spending much of his free time cycling, hiking, running and swimming. He played basketball in school and still likes to hit the court when he gets the chance.

Bansal has several family members who are also in the medical field. One brother is a resident in Columbia, Mo.; several uncles are doctors. His parents are business owners in India.

Read more: http://www.thetelegraph.com/articles/bansal-60430-medical-medicine.html#ixzz1aqpNAJXA

Yes, President Abraham Lincoln and Mother Theresa.

Though clearly he could have never met the former and didn’t have the opportunity to meet the latter, Wooden correctly points out that as individuals we can be mentored by the writings, words, and thoughts of people we have never and will likely never meet.

Which seems like the most opportune time to thank one of my mentors, founder and former CEO of Apple, Steve Jobs.

Now, I have never met nor will I ever meet Steve Jobs.  Lest you think I’m a devoted Apple fan, I never bought anything from Apple until the spring of 2010.  Their products though beautifully designed were always too expensive.  I’m just a little too frugal.  I know technology well enough that people mistaken me for actually knowing what to do when a computer freezes or crashes.  Yet, the value proposition was never compelling enough until the release of the first generation iPad.  Then the iPhone 4.  Finally the Macbook Air last Christmas.

No, thanking Steve Jobs isn’t about the amazing magical products that have changed my life as well as millions of others.  It’s more than that.  What he has mentored me on is vision, perspective, persistence, and leadership.  Nowhere is this more important than the world I operate in, the world of medicine.  Increasingly health care is fragmented, confusing, and frustrating for patients.  As Dr. Atul Gawande noted in his commencement to Harvard Medical School:

Everyone has just a piece of patient care. We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care.

We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It’s like no one’s in charge—because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people.

We don’t have an actual system of care.  A majority of doctors still use paper charts and prescription pads which can be difficult to access or decipher (doctors have poor penmanship?) and communicate with colleagues via letters, faxes, and phone calls.  In an industry which is information driven, this seems too antiquated to be true.  Hospitals each have their own unique system of care and their is little standardization which means both patients and doctors need to learn new rules with each new hospital.  Patients cannot invest in long term relationships with their doctors because they change jobs, their company or their doctors dropped their previous insurance plan.

What we have is a potpourri of doctors, hospitals, pharmacies, and health insurers cobbled together to form a “health care system”.  For a patient, the number of combinations is staggering.  Each experience varies depending on who they see, what insurance coverage they have, and the type of (or lack of) information technology their doctors have.  Many doctors today still bristle at the possibility that they actually need to email their patients and as a result don’t offer that as a way of communication or education.

In the end, what patients and doctors really want sits at the intersection of humanity and technology.  Patients want doctors who know them as individuals, use medical technology thoughtfully, and a system that is highly reliable, safe, and focused on them to stay well or get them better.  Doctors want patients who are partners in their care, technology that enables them to get the accurate information they need real-time, and a system that is streamlined to allow doctors to be healers.

In other words, we need a better health care system for both parties.

As a practicing primary care doctor, his words inspire me to help work towards creating a system which “simply works” for both doctors and patients.  Some of the most important quotes that has shaped my thinking include:

“Innovation has nothing to do with how many R&D dollars you have. When Apple came up with the Mac, IBM was spending at least 100 times more on R&D. It’s not about money. It’s about the people you have, how you’re led, and how much you get it.”
— Fortune, Nov. 9, 1998

“It’s really hard to design products by focus groups. A lot of times, people don’t know what they want until you show it to them.”
— BusinessWeek, May 25 1998

“It comes from saying no to 1,000 things to make sure we don’t get on the wrong track or try to do too much.”
— BusinessWeek Online, Oct. 12, 2004

“Do you want to spend the rest of your life selling sugared water or do you want a chance to change the world?”
— The line he used to lure John Sculley as Apple’s CEO, according toOdyssey: Pepsi to Apple, by John Sculley and John Byrne

“So you can’t go out and ask people, you know, what the next big [thing.] There’s a great quote by Henry Ford, right? He said, ‘If I’d have asked my customers what they wanted, they would have told me “A faster horse.” ‘ ” – CNN / Money

“My job is to not be easy on people. My job is to make them better. My job is to pull things together from different parts of the company and clear the ways and get the resources for the key projects. And to take these great people we have and to push them and make them even better, coming up with more aggressive visions of how it could be.” – CNN / Money

“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma — which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.” – Stanford 2005 commencement address

Many of my blog posts have reflected on whether health care can indeed be better than it currently exists much the same way Jobs has redefined how we as a society communicate, relate, receive, and create content.

Does America Want Apple or Android for Health Care? 

What Steve Jobs and iPhone 4 Antennagate can Teach Doctors and Patients

Why Healthcare Needs to be More Like Apple and Less Like Windows / Intel 

I as a doctor I’m incredibly sorry that medicine has not yet evolved to the point that a cure exists for the rare type of cancer Jobs.  I’m sorry that he is so ill at an incredibly young age, in his mid 50s, when many people begin to contribute even more to society with all of the knowledge and experience they’ve acquired.  The future might be a little less bright without Jobs leading his team at Apple on creating products and experiences none of us truly knew existed until he showed them to us.

And yet, I wanted to thank him for his mentoring.  Clearly though the outpouring of comments and support across the web, Steve Jobs has had a profound influence in many of our lives.  In most cases, it wasn’t even about the products.

It was simply a way of living and viewing life.

I look forward to learning one last time from my mentor this fall with the release of his book titled Steve Jobs. 

My thoughts are with him, his family, and the people at Apple who continue to innovate and challenge themselves so the rest of us benefit.

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of Stay Healthy, Live Longer, Spend Wisely.

During the past 40 years, seemingly overnight, overweight and obesity rates in the United States and other industrialized counties have soared among all age groups.
The problem is of such concern that it has earned “disease of the month” and “epidemic” status: September is officially National Childhood Obesity Awareness Month. The nature of this epidemic has been so insidious that while it has “happened right before our very eyes,” we see it less and less as larger children seem more and more normal.

According to the Trust for America’s Future, Maine has become the most obese state in New England and is now ranked 27th among the other states. In 2009, Maine ranked 35th. Approximately 60 percent of U.S. adults and 31 percent of children ages 2-19 are at an unhealthy weight.

While obesity has doubled in children, it has tripled in adolescents. Obese young people have an 80 percent chance of being obese adults.

In a recent issue of the journal “Childhood Obesity,” former Surgeon General Dr. David Satcher speaks to why this epidemic is occurring, “Sedentary lifestyles and unhealthy eating habits have spread from adults to children. Changes across our society and environments have conspired to create this unintended problem, and an investment across sectors of society is needed to turn it around.”

Carrying around excess weight has a number of significant consequences that can be psychological, physical and academic. Children of a healthy weight perform better on standardized tests, feel better about themselves and are more able to remain physically active.

Of paramount concern to parents, health care providers and economists, however, are the increased risks of serious chronic illnesses that go hand in hand with unhealthy weight.

One in three children born in 2000 will develop Type 2 diabetes in their lifetime if this trend continues. Risk of heart disease, sleep apnea, stroke and some types of cancer will be on the rise.

Obesity-related medical costs are currently 10 percent of all annual medical spending, and people with unhealthy weight have more sick days, more medical claims and poorer quality of life.

Recommendations for actions to combat this epidemic and the associated alarming trends come from a number of organizations, including the federal Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, the Institute of Medicine, the American Academy of Pediatrics and first lady Michelle Obama’s leading project called Let’s Move.

Here’s a sampling of some of the top suggestions that we, as a community, could implement:

— Schools: Our children eat one to two meals per day, five days a week at school. By focusing on whole foods, fruits and vegetables, and cooking from scratch rather then offering salty processed foods, school nutrition programs are doing their part to improve nutrition overall.

Schools also can make a difference by expecting healthy food for celebrations and fundraisers, strengthening health curriculum, developing school gardens, encouraging walking or biking to school, and establishing opportunities for movement throughout the school day. In our area schools, these and other improvements are happening.

— Health care: Pediatricians can use the well-child visit to weigh their patients and discuss what a healthy weight is with parents or caregivers.

The American Academy of Pediatrics recommends this regular assessment of weight, and also provides a number of suggestions to help parents make changes at home to support a healthy weight for their children.

Specifically, the academy suggests, among many things, removing the TV and computer from bedrooms, eating breakfast every day, limit eating out, involving the whole family in healthy behavior change and eliminating sugar-sweetened beverages.

— Families: Parents and family members can support their children’s health by ensuring adequate family time for physical activity, encouraging low fat milk and water consumption, and discouraging sugar-sweetened drinks, sending fruit or veggies for snack, getting involved in the establishment of strong school wellness policies, and limiting screen time.

— Others: There are many opportunities for other community members to encourage healthier choices.

Towns can establish neighborhoods where people feel safe to walk, ride bikes and exercise.

Restaurateurs can help by offering healthy choices, small portions, nutrition information about their offerings and reducing the use of salt in their recipes.

Youth recreation leagues can provide healthy snacks for players and at snack bars and in vending machines.

For local and national resources that support physical activity and healthy eating, visit www.accesshealth.org.

Marla H. Davis, MDN, RN, is director for Community Health Improvement at Mid Coast Hospital in Brunswick. She also works with ACCESS Health, the region’s Healthy Maine Partnership, the Sagadahoc County Board of Health, the United Way, YMCA, and other community groups on projects of shared interest. She also has a clinical practice providing tobacco treatment to inpatients and outpatients. She lives in Bath.

In statistics used to underline the unequal access to food, the IFRC stressed there were 1.5 billion people suffering obesity worldwide last year, while 925 million were undernourished.

“If the free interplay of market forces has produced an outcome where 15 percent of humanity are hungry while 20 percent are overweight, something has gone wrong somewhere,” secretary general Bekele Geleta said in a statement.

I agree that distribution looks a little uneven there but look past that to the much greater point underneath.

As PJ O’Rourke put it some years ago, for us in the rich world the problem is where to have lunch instead of will there be lunch or are we to be lunch? And as we can see from the figures presented, this solving of the great probnlem is moving steadily down the income scale.

We know very well that our ancestors were much smaller than we are: in height, not just waistband. The usual assumption is that they were badly nourished. Now, for 85% or more of the species this problem has vanished, we’ve only 15% of us left holding that short end of the stick. And if the projections for what is going to happen this century are anything to go by (for example, the models used by the IPCC to show that we’ll have climate change also show that absolute poverty will be abolished in the coming decades) then we’re going to solve that problem too.

Making sure that we’re not all fat porkers might be a more difficult problem though. For the big and major problem we’ve had for the roughly 100,000 years of the existence of our species is managing to get enough food. A problem we’ve just about managed to solve, only 200 years after we started using this strange system of markets and capitalism.

That’s really not bad you know, solving the biggest problem we’ve faced since Granny was knee high to an Australopithecus.

BY KIM JANSSEN Staff Reporter kjanssen@suntimes.com September 16, 2011 11:26PM

Jeffrey Lisitza, 56, of Arlington Heights, has lost more than 100 pounds through diet and exercise in his attempt to control his Type II diabetes. | Dom Najolia~Sun-Times

The Center For Disease Control estimates that 25.8 million U.S. children and adults have diabetes, about 8.3 percent of the population. Diagnosed cases compose 18.8 of that total, with undiagnosed cases accounting for 7 million.

There are two major types of Diabetes:

Type 1

◆ Compose about 5 percent of diabetes cases.

◆ Typically diagnosed in children, teenagers and young adults.

◆ Develops when the pancreas doesn’t produce insulin because the immune system has destroyed the organ’s beta cells, the only cells that make insulin.

◆ Might be caused by genetics, environmental factors or other reasons.

◆ People with Type I can’t survive without regular administration of insulin via injection or a pumping device. Other treatment options include a healthy diet, exercise and reining in cholesterol and blood pressure.

◆ No known method of preventing Type 1 diabetes.

Type 2

◆ Responsible for 90-95 percent of all cases.

◆ Can develop in people at any age.

◆ Caused by insulin resistance, a condition brought on when liver cells, fat and muscle can’t use insulin properly.

◆ Obesity, old age, family history of diabetes, and race and ethnicity are common risk factors. African Americans, Hispanic/Latino Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islanders are particularly at risk.

◆ Healthy eating, exercise and weight loss are usual treatments. Treatment can also include oral medicine or insulin.

◆ Can be prevented by frequent physical activity and a healthy diet.

Source: Centers for Disease Control and Prevention

Adeshina Emmanuel

ARTICLE EXTRAS

View Gallery

Updated: September 18, 2011 8:27AM

Jeffrey Lisitza watched helplessly as diabetes ravaged his father’s health.

First it took his legs.

Then it took his vision.

Finally — 10 years ago — it took his life.

Lisitza, of Arlington Heights, knew better than most the risks of obesity. But the 56-year-old’s own weight ballooned to more than 350 pounds, and he too was diagnosed with Type II diabetes.

“I was tired all the time and I didn’t want to do anything,” he recalls. “I couldn’t even chase my kids around the house, take them to the zoo, or go to a Fourth of July festival.”

Lisitza has since lost 115 pounds and turned his life around, though the fingertips of what he calls his “steel hands” are still calloused black from years of pinprick blood sugar tests.

His case may sound extreme, but with more than 1 in 9 Chicagoans suffering from diabetes, chances are you know someone facing similar challenges.

A global diabetes epidemic now affects a “staggering” 366 million patients worldwide, causing death every seven seconds, the International Diabetes Federation warned last week. “The clock is ticking for the world’s leaders,” Jean Claude Mbanya, the group’s president, said in a statement.

And in some Chicago neighborhoods, as many as 1 in 4 people may now have diabetes — many unwittingly, local advocates say.

Though global health leaders have for decades focused on battling infectious diseases such as AIDS, tuberculosis and new flu bugs, the UN General Assembly will next week hold its first summit on the chronic diseases that kill 9 out of 10 Americans: cancer, heart and lung disease, and diabetes. U.N. Secretary-General Ban Ki-moon calls the chronic diseases, which have common risk factors and are often preventable, “a public health emergency in slow motion.”

Diabetes — which renders sufferers’ blood sugar levels too high, either because not enough insulin is produced or because cells do not respond to the insulin that is produced — has grown from 5.6 million diagnosed cases in 1981 in the United States to 19.7 million in 2009, according to the Centers for Disease Control and Prevention. If undiagnosed cases are included, that figure is estimated to have grown to 26 million by this year.

Because of a growing, aging population, increasingly widespread obesity and, in part, to African-Americans’ and Latinos’ higher risk of diabetes, the CDC expects the 1.1 million diabetics in metropolitan Chicago to have increased by 500,000 to 1.6 million by 2025.

The vast majority of diabetics suffer from Type II diabetes, which is often tied to obesity and is typically diagnosed later in life. But doctors are struggling to explain a similar rise in Type I diabetes, which is more often diagnosed in children and unrelated to weight. It is more commonly known as Juvenile Diabetes.

The disease can be managed with diet, exercise and medication including insulin, but chronically high blood sugar levels cause nerve damage, which can result in kidney disease, blindness and amputation.

Those leading the fight against diabetes say next week’s U.N. meeting offers a key opportunity to focus minds and set meaningful targets.

Prof. Louis Philipson, who leads the University of Chicago’s Kovler Diabetes Center, said governments around the world need to do more to teach people to exercise more and eat diets that are low in calories and high in protein and fiber.

And he said that the “mostly reactive, not predictive” nature of the health-care industry means there is a shortage of specialists ready to deal with the explosion of diabetes cases expected to hit Chicago in the coming years.

In neighborhoods such as North Lawndale or Humboldt Park, studies suggest as many as 1 in 4 residents may have diabetes, according to Jeanette Flom, the executive director of the Chicago branch of the American Diabetes Association.

“Major employers are coming to us, asking for advice, because this has become such a big risk for the health of their staff,” Flom said. “It’s a sensitive topic and maybe people don’t want to discuss diabetes in the workplace, but it affects so many people in so many ways.”

Though diabetes has become big business with pharmacies devoting an aisle to diabetics, diabetic candy and iPhone apps for tracking blood sugar, a cure remains elusive.

Treatments such as those pioneered at the University of Illinois’ Chicago Diabetes Project have provided hope for some.

Mokena nurse Cynthia Beaumont, 45, is one of a handful of Type I diabetes patients to have benefited from an experimental procedure in which cells from an organ donor’s pancreas are injected.

Beaumont, who was diagnosed with diabetes at age 2, had relied on an insulin pump and had to prick herself to test her blood sugar 10 to 12 times a day until she received the treatment last September.

She’s now able to exercise and do her job without fear of a dangerous lapse in concentration and declares her life “transformed.”

“I can do the things I always wanted to do — take a bike ride with my family, run on the treadmill or just keep going all day without worrying,” she said.

The Chicago Diabetes Project director, Dr. Jose Oberholzer, said he expects the transplants to remain the most promising way forward for the next decade.

He cautions that they are available only to a tiny proportion of Type 1 patients, but hopes to develop a treatment for Type II patients that does not require costly injections.

“Health insurance doesn’t pay for this treatment yet,” he said. “People are running sponsored marathons, writing grant proposals and fundraising to pay for this, and it shouldn’t be that way.

“If there was proper funding, we could find a cure — it cannot be that difficult,” he said.

“But prevention is even more important.”

I bet you’re surprised to read this. While there are many “no brainers” on the CDC’s list — such as tobacco control, motor vehicle safety and heart disease improvements — scary statistics and media reports suggest that we’re losing the obesity fight.

To be sure, obesity rates only increased over the past decade, continuing the epidemic rise that has progressed over the past half-century. But hidden underneath the scary statistics is quite a bit of good news:

• Today, we have a national dialogue on obesity. This is a very recent shift. A decade ago, we weren’t talking about obesity (except to call fat people “lazy” and “stupid” and the like). There is now regular discussion about this epidemic, both in terms of improving the evidence base for individual treatments and how to mount an effective population-level approach.
• We now generally accept that obesity is a serious health problem, rather than simply a cosmetic issue. In a study that my colleagues and I currently have in press, we show that a number of key public health messages are penetrating society. The vast majority of Americans we surveyed recognize that their weight can affect their health. The vast majority of physicians polled acknowledge that they have a responsibility to help their patients with weight management.
• More information is now available than ever before. The internet is chock full of great resources for individuals, parents, kids, schools teachers, doctors and others wishing to learn more about weight and health. (Of course, the reliable resources are awash in a sea of nonsense – caveat emptor, as always, still applies. Feel free to email me and I’ll do my best to point you in the right direction.) Schools are beginning to teach skills for healthy nutrition and physical activity. Workplace wellness opportunities are growing. Calorie labeling in restaurants will help millions to make healthier choices while dining out.
• Practitioners are slowly moving beyond simply lecturing patients to “eat less, exercise more,” and thinking about the underlying causes and contributors of individuals’ weight problems. Recentresearch has shown that primary care doctors can effectively implement comprehensive strategies to help their patients manage weight.
• The public and private sectors are on board. Governments, communities, schools, organizations and even the food industry, are working to address the policies, settings, contexts and environments that set the stage for weight gain and obesity. Sure, each of these stakeholder groups can — and must — do more. But to have all of them working toward some common goals is a small victory in itself.
• Significant research, advocacy and policy discussions about weight bias are now occurring daily. Though the level of vitriol has seemingly increased (as evidenced, I’m sure, by the hateful anti-fat comments that will likely appear below this post), we’re now having real and informed discussions about the obesity epidemic, how to address the societal drivers of weight gain, how to support persons who have obesity and where to go from here.

We certainly have a long way to go, and the surface stats don’t add up — yet. But progress has to start somewhere.

I believe that in the past decade we’ve set the stage for a revolution in the way we approach obesity — both clinically and on a population level. When obesity rates begin to decline, we’ll look back at this decade as having sown the seeds for success. It’s not going to be easy, but I like our chances.

And I look forward to CDC’s next report — due in 2021 — in which I’m confident obesity treatment and prevention will claim a prominent ranking.

In fact, a recent example of a successful weight management program run in primary care just found considerable media attention in local newspapers.

But research shows that most general practitioners (GPs) neither feel confident nor effective in managing excess weight in their patients, and many would rather not bring up the topic of weight management at all.

So what about GP trainees? After all, the next generation of GPs will have little choice but to devote a considerable proportion of their time and practice to dealing with weight-related health issues.

This question was now addressed by Jochemsen-van der Leeuw and colleagues from the University of Amsterdam, in a paper published in Family Practice.

For this study, the researchers conducted focus groups of first- and third-year Dutch GP trainees and their teachers regarding their attitude, willingness, and ability to provide lifestyle interventions for overweight patients.

First-year GP trainees clearly lacked both knowledge and a positive attitude towards addressing weight management.

Perhaps more alarmingly, even third-year trainees, despite being trained in motivational interviewing techniques, also lacked specific knowledge and appeared rather unenthusiastic about providing lifestyle advice.

These attitudes most likely reflect the fact that their trainers were generally despondent about weight management and reported to have rarely observed long-lasting results. In fact, these teachers regularly warn their trainees not to have high hopes.

Tainers and trainees both feared ruining the relationship with their patients by bringing up the issue of weight management and rather preferred having patients enter evidence-based multidisciplinary treatment programmes. They also called for an image change in society to stop the epidemic.

The finding in this study (which I am sure are not just limited to Dutch trainees) are alarming, as they demonstrate that GP trainees are still leaving school without feeling any more competent in treating overweight patients than their trainers.

Under these circumstances, there is indeed little hope that the next generation of GPs will be any better prepared to provide evidence-based weight management advise to their patients than the current generation of GPs.

As the researchers point out, there is an urgent need for a drastic attitude change towards acquiring the competency and efficacy to provide evidence-based obesity treatments both amongst GP trainees and (perhaps even more importantly) amongst their teachers.

Indeed, no GP training program should be allowed to continue graduating doctors, who do not understand even the basics of weight management or do not see this as an important part of their medical practice.

Of course, there are numerous GPs, who are turning their attention to weight management and (as in the example cited above) are beginning to see considerable results in their patients.

If you have had a positive experience with your GP regarding weight management, I’d certainly love to hear about it.

If you are a GP offering weight management advise to your patients, let me hear whether you consider this a worthwhile effort or a waste of your time.