Fat City: One Area Ripe for Rationing

Fat City: One Area Ripe for Rationing

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The U.S. Preventive Services Task Force is at it again. This time, the government-appointed panel is on fat patrol. Its review of the medical literature found that diet and exercise combined with group counseling beat popping a pill when it comes to controlling weight.

For those with short memories, USPSTF is the government panel that in the midst of the health care reform debate had the temerity to suggest the evidence was iffy on the wisdom of mammography for women under 50. Check with your doctor before deciding if an early start to routine breast cancer screening was right for you, they said.

Conservatives had a field day. "We don't know how far government will go in this bureaucracy,” cried Rep. Michele Bachmann, R-Minn., who a few months later launched her presidential campaign."This is how rationing begins,” intoned Rep. Marsha Blackburn, R-Tenn.

When it comes to obesity, though, a little food rationing is just what the doctor ordered, according to the latest from the USPSTF. How one rations matters, however.

“With drugs, when people stop, they gain the weight back,” said David Grossman, a senior investigator at Group Health Research Institute in Seattle and chairman of the 16-member panel that issued the updated guidelines on obesity prevention on Tuesday. “This is a lifestyle problem. If you don’t change your lifestyle, drugs are not likely to provide a long-term solution.”

Michelle Obama wasn’t taking the easy path when she chose the obesity epidemic and childhood obesity in particular as her main cause. Since the late 1970s, the number of people considered obese grew by half and now totals 32 percent of men and 36 percent of women. One in 20 Americans are now considered morbidly obese. By 2030, if nothing is done, those numbers are expected to grow to over 40 percent obese with over 10 percent morbidly so.

The chronic conditions associated with lifelong obesity – heart disease, diabetes, increased rates of cancer – are one of the major reasons why health care costs are rising as fast as they are. And it doesn’t even help much. The chronically obese, even after a lifetime of treatment for their fat-related disorders, lose anywhere from six to 20 years in life expectancy.

Given its rising incidence, the drug industry has been pursuing new drugs to combat the obesity epidemic like Knights of the Roundtable pursuing the Holy Grail. But the field is littered with failure. Older drugs have been withdrawn for safety reasons (remember Fen-Phen, which caused fatal heart problems?) or failed to catch on because of nasty side effects (Orlistat).

Two new drugs being considered by the FDA will probably win approval soon. But they also have side effects (one has half the Fen-Phen combination). More significantly, according to USPSTF, there are still major questions surrounding the durability of results from taking pills to control weight.

While billions are poured into the search for a magic pill, health insurers and local groups like the YMCA are looking for more pragmatic, low-tech solutions like the one recommended by USPSTF. Although it is counterintuitive, it turns out that the counseling approach is most cost-effective, too.

At a recent briefing on Capitol Hill, a spokeswoman for Wellpoint described how her company was now paying for free counseling for kids identified as obese through targeted screening. The YMCA has turned the government-created diabetes prevention program (intensive one-on-one counseling) into a group counseling program that has succeeded in helping people lose 5 to 7 percent of their weight on average.

More significantly, fewer people with high blood sugar did not graduate into full-blown diabetes once in the program. “It’s saving so much money and really changing peoples’ lives,” said Katie Adamson, director of the program for the YMCA of the U.S.A.

The USPSTF gave the counseling approach to controlling obesity a ‘B’ rating, which means under the Affordable Care Act that insurers will have to cover its cost with no co-pays to the insured. It’s one of the major insurance coverage provisions that may get axed when the Supreme Court hands down its decision on Thursday.

spent 25 years as a foreign correspondent, economics writer and investigative business reporter for the Chicago Tribune and other publications. He is the author of the 2004 book, The $800 Million Pill: The Truth Behind the Cost of New Drugs.