We need to change the way obesity is treated, says Vash
The medical response to the obesity epidemic is
"clouded by misunderstanding, bias, and stigma,"
Peter Vash, MD, MPH, tells in this installment of 10 Questions.
Vash is an internist and endocrinologist with speciality in obesity medicine. He is an assistant clinical professor of medicine at UCLA Medical Center. He has served as president for the American Society of Bariatric Physicians (now known as the Obesity Medicine Association) and on the board for The North American Society for the Study of Obesity (NASSO). He is the author of 'Lose it and keep it off'.
1. What's the biggest barrier to practicing medicine today?
The three biggest barriers to the practice of medicine today are:
achieving and delivering of quality care to the patient,
providing access to care for the patient,
and securing payment for care of the patient.
All three factors must be addressed and satisfied for the cost-effective delivery of high-quality care.
It's hard to believe, but the healthcare system can sometimes be an obstacle to people who are affected by obesity and are trying to achieve a healthy weight. Even though obesity was designated as a disease by the American Medical Association in 2013 and accounted for an estimated $316 billion in healthcare costs in 2010, we aren't seriously talking about how to encourage a comprehensive approach to treatment that considers all available evidence-based medical strategies, including diet and exercise modifications, medication, and bariatric surgery.
There really needs to be a change in the way health professionals, policy makers, and the public approach treating people with obesity. We must all commit to implementing a comprehensive management approach that considers all evidence-based medical strategies.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds, tests, etc.) and how did you respond?
I once saw a patient and his family, transient and on the move, hungry and without food, and in need of medications. I gave the patient and his family food from the practice refrigerator and then gave him samples of his needed medications.
This was an extreme case, but it's important for us to think about what external factors influence our patients when we're working with them to achieve a healthy weight. If we advise eating healthy and exercising, do they have access to healthy affordable food and safe places to be active? If we advise treatment with medicine or surgery, will the patient's insurance cover it?
Providing treatment for obesity is complex, and that is why it's important to start a national dialogue about how we care for people affected by obesity.
3. What do you most often wish you could say to patients, but don't?
Communication is key to providing sound medical advice and if I feel that something is in the patient's best medical interest, I usually say it. But, how you say it is as important as what you say. Despite recommendations that healthcare professionals consider all available evidence-based medical strategies, a survey by The Associated Press-NORC Center for Public Affairs Research found that nearly one-half of people affected by obesity say they have not been advised by a physician about how to maintain a healthy weight.
Interactions are very important when working with patients to develop a comprehensive weight-loss plan. Sometimes appropriate, well-intended advice given by physicians may be perceived as patronizing by patients. I believe healthcare professionals could better engage with the patient by ensuring they are delivering practical advice in a compassionate manner.
4. If you could change or eliminate something about the healthcare system, what would it be?
The healthcare system as a whole has a brilliant, intricate design that I truly believe tries to put the patient first. Unfortunately, sometimes the healthcare system struggles with hypocrisy and callousness, which undermines the care and treatment of the patient.
Overall current medical response to the obesity epidemic is clouded by misunderstanding, bias, and stigma. There is a need to overcome the bias against people affected by obesity to enhance our effort to effectively treat and prevent obesity. It has a lot to do with the pace of adoption of new attitudes and new medicines. AMA didn't even consider obesity to be a disease until 2013, and it was still pretty controversial.
Many healthcare professionals continue to mistakenly view obesity only as a lifestyle choice, rather than a complex disease influenced by physiological, environmental, and genetic factors. And even though the latest guidelines by the American Heart Association, the American College of Cardiology, and The Obesity Society would recommend that more 50% of people in America are eligible for treatment with medication, Medicare doesn't cover it. We need to pass an act of Congress to allow Medicare beneficiaries access to modern medicine.
That's why I've joined more than 35 leading U.S. healthcare organizations -- together representing more than 800,000 healthcare professionals -- for National Obesity Care Week, an unprecedented public awareness campaign to encourage a comprehensive approach to treatment that considers all available evidence-based medical strategies. While awareness initiatives aren't enough to solve the challenges that exist in how we care for people affected by obesity, they are critical to promoting a national dialogue about broader solutions and offer useful resources that will help professionals and patients alike.
5. What is the most important piece of advice for healthcare providers just starting out today?
Do not lose your humanity and your desire to care for your patients, and recognize that there is
"a sacred space"
between the patient and the physician that must not be tampered with.
Given the impact that obesity has on our healthcare system, it's important to be educated on obesity and weight stigma. The American Board of Obesity Medicine offers a certification process for education and competency in treating obesity, and there are a lot of resources available through organizations such as The Obesity Society (TOS), the Obesity Action Coalition (OAC), Strategies to Overcome and Prevent (STOP) Obesity Alliance, the American Society for Metabolic and Bariatric Surgery (ASMBS), and National Obesity Care Week.
6. What is your "elevator" pitch to persuade someone to pursue a career in medicine?
It's still a privilege to be a physician; it is a noble and fulfilling calling. Beyond possible fame and fortune, it can provide a meaning and a sense of purpose to one's life.
7. What is the most rewarding aspect of being a healthcare provider?
Helping your patients heal, thrive, and become productive, caring, and empathetic individuals. There is nothing better than connecting on a professional-personal level with patients by taking the time to build the patient-physician bond. Once that bond is created, it opens the door for open communication between the patient and physician that increases comfort of healthcare professionals and patients in discussing and/or treating obesity in medical settings.
8. What is the most memorable research published since you became a physician and why?
Thankfully, the most memorable research published changes every day and all research serves as a guiding light.
Right now, I think it's important to educate healthcare professionals about a number of studies and guidelines about treating obesity. For instance, according to recent guidelines for obesity care, almost two-thirds of American adults are recommended for weight-loss treatment. Of those, more than eight in 10 should be considered for treatment with medication, and almost one in four could be candidates for bariatric surgery. The fact is many of us struggle with maintaining a healthy weight, and we all have loved ones who do.
There are also a number of great studies that dispel the myth that a major reduction in weight is required to experience benefits, when in fact, weight loss of 5% to 10% improves obesity-related health risks, including hypertension, cardiovascular disease, hyperlipidemia, type 2 diabetes, and obstructive sleep apnea.
Ongoing research stimulates the desire for learning and understanding and sometimes wisdom.
9. Do you have a favorite medical-themed book, movie, or TV show?
Although I enjoy television and movies, they are overly-exaggerated and sometimes use comedy to the detriment of patients affected with obesity. As for books, I enjoy The Doctors Dilemma by George Bernard Shaw, a problem play about the moral dilemmas created by limited medical resources, and the conflicts between the demands of private medicine as a business and a vocation. Another is The House of God by Dr. Samuel Shem. The novel follows a group of medical interns at a fictionalized version of Beth Israel Hospital over the course of a year in the early 1970s, focusing on the psychological harm and dehumanization caused by their residency training.
10. What is your advice to other physicians on how to avoid burnout?
Don't let your passion for medicine die out, find ways to enjoy your work and avoid becoming cynical and jaded. Don't let the bureaucracy of practicing medicine frustrate and aggravate you. Take care of yourself because you are needed to help others.