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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Be Part of the Solution
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Jun Ma, Palo Alto, U.S.A. Stanford University School of Medicine
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Be Part of the Solution Obesity is an ever rising epidemic in the U.S. ¨ 1 in 3 adults is obese and 1 in 6 children overweight (Hedley, 2004) and it exerts enormous impact on people's lives and health care costs. Three of four obese and overweight Americans have at least one modifiable cardiovascular risk factor that would be favorably impacted by weight loss (USDHHS, 2001). Several clinical trials provide strong evidence for the effectiveness of structured lifestyle interventions in inducing clinically significant weight loss and marked improvements in disease outcomes (Wing, 2004; Appel, 2003). For example, in the Diabetes Prevention Program, intensive lifestyle intervention decreased the incidence of type 2 diabetes by 58%, compared with 31% in the metformin-treated group (Knowler, 2002). However, the effectiveness of intensive lifestyle interventions is largely unknown when implemented in routine clinical practice. As Sussman and colleagues pointed out in their article in the current issue of the journal (Sussman, 2006), the literature abounds with consistent data of low rates of preventive services in primary care practice, and many interventions aimed to improve the frequency and effectiveness of such services have shown disappointing results. Working within a principally acute care-centered health care system, most clinicians find themselves frustratingly unsuccessful at managing lifestyle issues such as weight management. In agreement with the existing literature, the study of Sussman et al. reveals the complex dynamics involved in clinicians' decision-making for the provision of preventive counseling. The complexity is embodied by the involvement of multiple factors at various levels (the health care system, the clinician, and the patient) and different time points (before and during the encounter). Complex problems require comprehensive and innovative solutions. The enormous clinical consequences of obesity demand that our health care system resolutely take on the mission of obesity management and integrate this task into primary care. To fulfill its role as part of the solution to confront the obesity epidemic, a reform of the current health care system is imperative and must address the many difficulties throughout the care delivery process that have been documented by Sussman et al. and others. Appel L J, Champagne C M, Harsha D W, Cooper L S, Obarzanek E, Elmer P J, Stevens V J, Vollmer W M, Lin P H, Svetkey L P, Stedman S W, Young D R, 2003 "Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial" Jama 289:2083-93. Hedley A A, Ogden C L, Johnson C L, Carroll M D, Curtin L R, Flegal K M, 2004 "Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002" JAMA 291:2847-50. Knowler W C, Barrett-Connor E, Fowler S E, Hamman R F, Lachin J M, Walker E A, Nathan D M, 2002 "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin" N Engl J Med 346:393- 403. Sussman A L, Williams R L, Leverence R, Gloyd P W, Crabtree B F, 2006 ¡°The art and complexity of primary care clinicians¡¯ preventive counseling decisions: obesity as a case study¡± Ann Fam Med 4:327-33. USDHHS, 2001 "The Surgeon General's Call to Action Prevent and Decrease Overweight and Obesity", (Rockville, MD: Rockville, MD). Wing R R, Hamman R F, Bray G A, Delahanty L, Edelstein S L, Hill J O, Horton E S, Hoskin M A, Kriska A, Lachin J, Mayer-Davis E J, Pi-Sunyer X, Regensteiner J G, Venditti B, Wylie-Rosett J, 2004 "Achieving weight and activity goals among diabetes prevention program lifestyle participants" Obes Res 12:1426-34. Competing interests: None declared |
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