Obesity and Departments of Family Medicine

Obesity is a national problem and one of great concern to many family medicine departments. That’s scarcely surprising given that an epidemic like obesity is unlikely to be affected by a traditional medical treatment model. Reducing obesity rates will likely require an integrated approach that brings local practitioners, community agencies, such as schools and health departments, employers, and researchers together for comprehensive prevention and treatment programs. Fortunately, combining medical and community/public health approaches is increasingly familiar territory to many family medicine departments.

A community-centered intervention is underway in several Philadelphia neighborhoods. Faculty and fellows from Thomas Jefferson’s Department of Family Medicine and the hospital’s Office to Advance Population Health are working with Penn State University’s Hamer Center for Community Design to conduct community assessments and develop action plans for modifying the local environment. These plans will create active living programs that encourage physical activity among community members of all ages.

Also in Philadelphia, the Department of Family Practice and Community Medicine at the University of Pennsylvania is involved in research efforts, funded by the American Heart Association and the National Heart, Lung, and Blood Institute, to compare different types of lifestyle interventions for obese African Americans.

Identifying the factors that make obesity a particular risk for minorities is also a topic of interest at Case Western and the University of Medicine and Dentistry of New Jersey medical schools.

Informatics plays a lead role at the Northeastern Ohio Universities College of Medicine. Grants from the Ohio Board of Regents Hayes Investment Fund, local foundations, and the US Department of Health and Human Services have funded the placement of touch-screen computer kiosks with patient information, linked to stages of change, in 8 clinics caring for the undeserved in northeast Ohio. Information is provided on exercise, smoking, weight control, and alcohol use. The goal is to provide targeted information both to inform patients at a level appropriate to their willingness to change and level of health literacy and to provide a stimulus for discussions between patients and providers.

Wake Forest University has long had a comprehensive weight management program based in Family and Community Medicine. Enrollment in the program has doubled in the last year, mainly as a result of negotiation with a major health insurance carrier to pay one half the cost. This all-inclusive program includs education and group and individual counseling, as well as nutrition and exercise advice. The program has set the stage for multiple educational and scholarly endeavors in the department and the medical center.

Residents are contributing to the solutions as well. At the Eastern Virginia School of Medicine, the department’s resident-sponsored weight management program explores the efficacy of a physician-directed group approach to weight loss and won a school award for research by residents. Among the departments of family medicine, internal medicine and pediatrics there are now plans for extending the model to additional community-based, underserved sites.

Perhaps the most comprehensive set of programs is managed by the Duke University Department of Community and Family Medicine. Grants from the Kate B. Reynolds Charitable Trust and the North Carolina Health and Wellness Trust Fund Commission totaling more than $20 million have created almost 50 obesity prevention or treatment programs in communities across North Carolina. Several programs span multiple counties, including one led by the North Carolina Academy of Family Physicians. Each incorporates local doctors, health departments, and community groups in programs to encourage exercise and better diet, especially among high-risk groups. Students on the family medicine clerkship are now starting to connect local practitioners to these community resources.

Obesity poses challenges for patients, for communities and the public as a whole, and for family medicine. Finding solutions that work for our patients is pulling all of us out of our usual way of providing care, into less familiar environments of partnerships between academic and community groups, and with local and state public health agencies. But finding new solutions to health care problems, such as obesity, is one of the central missions of the academic departments of family medicine and is one way departments contribute, not just to the discipline, but to improving health for all.

• © 2004 Annals of Family Medicine, Inc.