Reducing R.I. obesity

In 1990, the obesity rate in Rhode Island was about 10 percent. Today it’s 27.4 percent and according to the Robert Wood Johnson Foundation, projected to be more than 50 percent by 2030.

That means we are headed for having 500,000 obese people in Rhode Island vs. the current 300,000. This would raise the extra annual medical expense paid for treating obesity-related diseases in the state from $410 million to approximately $714 million, or $1,429 per person.

By any measure, we are dealing with an epidemic. The question is, how do we as a community attack the problem? I offer the following suggestions:

First, it is not realistic to think we can change the unhealthy food environment in our community. The entrenched interests in the agriculture, soda and processed-food industries are too powerful.

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The best option we have for fighting obesity is our health care system: Every time a medical professional engages an overweight or obese patient, it’s an opportunity to get them counseling and set them on the path to a healthier lifestyle.

But it doesn’t happen. And the reason is that our health care system is not set up to deliver effective treatment.

Currently, when a primary care physician sees an obese or overweight patient, the most they can do is talk to them about the need to lose weight. They do not have nutrition counselors on staff, nor do they have the facilities and staff to provide an ongoing weight-loss program where patients are monitored on a regular basis. The reason they don’t is that those treatments are not currently covered by insurance.

What I propose is a plan where Rhode Island creates a network of community wellness centers that provide medically supervised weight-loss counseling and treatment. Medical professionals can send their patients for treatment that is covered by insurance. I envision centers that are affiliated with local hospitals providing treatment for their patients and employees. Medical professionals in the area would be able to write prescriptions for patients sending them for a free assessment and counseling session. They would initiate treatment of obesity, in addition to the conditions caused by it.

The Affordable Care Act mandates free, preventative treatment for a number of diseases, including colonoscopies and annual physicals. The health care industry universally recognizes the value and significant cost savings of early detection and preventative care. However, when it comes to weight loss, the ACA language is vague, leaving the payment decisions with insurance companies.

Earlier this year, Humana Insurance, with 31 million customers and 52,000 employees, launched a partnership with Weight Watchers. Instead of balking at covering weight-loss programs and procedures, Humana recognized the financial benefits of helping their enrollees achieve healthy lifestyle behaviors that will save the company money in the long run.

From a management perspective, I suggest that the biggest impact that can be made is by implementing changes to the health care system. If it can pay for expensive bariatric surgery, why can’t it pay for nutritional counseling and medically supervised weight-loss programs? The obesity train is rolling down the track. Rhode Island is on a path to having a population that’s 50 percent obese, with all the disease, dysfunction and expense that goes with it.

It doesn’t have to be done all at once. Set up four or five community wellness centers that focus on addressing obesity and the other health problems caused by poor lifestyle behaviors that result in 75 percent of health care costs. See what happens. •

Chris Westerkamp is a principal at Noll & Associates Management Services.

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