Tread lightly when addressing obesity now to save health, financial costs later

Addressing health issues affecting your obese patients now instead of waiting until they develop medical conditions later can help save $3 billion in US health costs a year. However, you have to be careful how you discuss children’s obesity issues with their parents, researchers cautioned.

In a recent study (FOCUS on a Fitter Future, a collaboration of the National Association of Children's Hospitals and Related Institutions), researchers found that pediatric obesity costs $3 billion annually but that a significant percentage of that could be saved through efforts such as instituting a universal set of guidelines that pediatricians and other clinicians could follow. Without that, they said, insurance coverage for obesity is evaluated on a case-by-case basis, often to the detriment of the patient.

"With pediatric obesity, the focus has been on the related diseases that usually come later, such as diabetes, heart disease and hypertension," said lead investigator Wendy Slusser, MD, MS, medical director of the University of California Los Angeles (UCLA) Fit for Healthy Weight program at Mattel Children's Hospital UCLA. "However, what we see now is that the obese child or adolescent may suffer from gastrointestinal disorders, mental health issues and musculoskeletal problems such as backaches or knee problems. By investing in the health issues of today, we can improve the health conditions of tomorrow and ultimately impact the future costs."

Researchers of a Rudd Center for Food Policy and Obesity at Yale University study urged pediatricians to tread lightly when discussing the topic. This study found that parents prefer that physicians use terms such as “weight” or “unhealthy weight” instead of loaded words such as “fat,” “obese,” or “extremely obese.”

In this national sample survey, when asked how they would react to use of terms they found stigmatizing and blaming, 35% of 445 parents reported that they would find a new doctor, and 24% said they would avoid seeing the current doctor.

Parental influence on weight loss goes far beyond terminology, according to another recent study. German researchers found that family adversity and maternal depression and attachment insecurity played key roles in long-term success, defined as at least 5% weight reduction in a year. The strongest predictor of weight loss during the first year was maternal depression, according to the study, which also found that longer-term maintenance of weight loss was affected when mothers had issues of insecure and anxious attachment to the children.

In terms of managing weight issues, FOCUS on a Fitter Future found that issues facing children who are obese or overweight could best be addressed by a multidisciplinary intervention program including a health care team with a medical provider, a registered dietitian, a physical activity specialist, a mental health specialist, and a coordinator. The program should provide up to 75 hours of service to children who are overweight or obese, with the cost of those services recovered through savings in 6.5 years in a privately insured patient and in 3.5 years for a patient insured by Medicaid.

For the study, researchers reviewed programs at 15 children's hospitals participating in the FOCUS on a Fitter Future collaborative and 1 nonparticipating hospital, identifying 5 cost-effective programs ranging in duration from newly launched to in existence for 20 years.

"Why can an obese adolescent get coverage for bariatric surgery to lose weight but not all the services that could help that child avoid surgery in the first place?" asked investigator Daniel De Ugarte, MD, surgical director of UCLA's Fit for Healthy Weight program.

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