By Morgan Downey

At this time of year, millions of Americans are hoping the new administration will solve our seemingly intractable problems at home and abroad. Millions are also hoping to lose weight in the new year. The two are not unrelated.

Over the past three decades, obesity has increased among all segments of the population, in the United States and abroad. Obesity is now recognized as the fuel behind many major health problems and a significant cause of increasing health care utilization and health care costs.

The efforts of the last eight years have been largely educational: tell people they should lose weight, eat more nutritiously, exercise more and hope. It has not worked. Other than surgery, nothing works very well to lose significant amounts for a long period of time.

If we do not know how to truly prevent obesity or create a long term treatment, what should a new administration do? It should do the next best thing: focus on how to create the conditions where it is more likely than not that we will find effective strategies for prevention and treatment in the future. So here are three ideas for the new administration.

First, the president-elect’s no-sweets-heavy-exercise regimen, while admirable, is no substitute for sound policies. Federal efforts show little outcome because no one is in charge of coordinating research, prevention and treatment of obesity.

Better research is the sine qua non of the future of obesity. Perhaps 90 percent of what we know about obesity has been learned since the discovery of leptin in 1994. Too many people believe that we know everything we need to know about obesity and do not need any more research. That’s not true. A great deal is known but there are many more questions than answers. Scientific credibility on issues around body weight is sorely needed. Every hour on television another weight loss program or product is hyped as being based on doctor’s advice or scientific study. What can help on both fronts is for the administration to create a National Institute of Obesity Research at the National Institutes of Health. A new entity like this can reenergize researchers on obesity, provide leadership to other federal agencies, states and local governments and provide much needed focus on the social and economic impacts of obesity. Furthermore, a director who is articulate can help lead policymakers and the public away from harmful and dangerous products and keep a focus on developing effective interventions. A National Institute can support research on childhood obesity programs, environmental solutions and be a focus of international efforts.

The NIH bureaucracy opposes “disease specific” research but their interests should not trump the public health needs and the best use of taxpayer dollars.

Second, as part of the health care reform package, remove the bias against drugs for weight loss in the Medicaid statute and change the exclusion of these drugs under Medicare Part D. There are few fans of pharmaceutical companies in a Democratic Congress and administration and there are even fewer who favor drugs to treat obesity. Nonetheless, there is a huge treatment gap. We do not have the drug treatment options for obesity we have for high cholesterol, hypertension or diabetes. Recently, major pharmaceutical companies have dropped or cut back on their programs to develop drugs for obesity. One reason is that insurance companies will not reimburse for most obesity treatments, including counseling, drugs and surgery. For the pharmaceutical industry, it just does not make economic sense to invest in drugs which were not going to be reimbursed. This is where leadership by Medicaid and Medicare is critical. If these programs support obesity products, private insurance may follow. A National Institute of Obesity Research can help shape clinical trials needed by the FDA and speed the process along.

Third, look to multiply your opportunities. For example, you can use the public works part of the economic stimulus package to construct new gyms in schools, sidewalks, playgrounds, green spaces and biking/walking trails to encourage more physical activity.
Downey is the former executive vice president of The Obesity Society and has worked in obesity advocacy and education for over 10 years.
Copyright (C) 2009 by the American Forum. 1/09


Unknown said...

How can we fight obesety? Difficult question...
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