First, the evidence base supporting clinical and population health approaches to obesity management has grown appreciably in the past couple of years.
Second, insurers, private employers, and health policy opinion leaders have begun to respond with appropriate urgency to the potential impact of obesity on the health of the U.S. population and the nation's health economic structure.
Most readers of MedPage Today are aware that about one-third of Americans are obese, and that obesity is closely associated with diabetes, cardiovascular disease, and other disabilities. The problem for people making health policy decisions, including employers and insurers, is that the evidence base available to guide population-based programming and clinical protocols has been sparse.
Fortunately, this evidence gap is beginning to close.
One example is a groundbreaking study recently published in the New England Journal of Medicine (Shai, et al, 2008). This study demonstrated that a long-term diet intervention, supervised by a registered dietician, yields lasting results. (See Low-Carb and Mediterranean Diets May Equal Watching Fat Intake)
The real news here was not about weight loss, but about adherence.
An impressive 95 percent of participants stayed with the diet at one year, and 84 percent persisted at two years. With rare exceptions, earlier clinical trials of behavior-based weight-loss interventions showed promising short-term results, but most participants gained weight back in less than a year after study periods ended.
What made the difference? A population-based approach.
Most of the earlier trials limited interventions to six months or less. Invariably, follow-up data showed that most participants did not adhere to the newly acquired behaviors after the studies concluded. Study participants usually gained back almost all of the lost weight a year or two post-intervention.
Hopefully, the work of Shai will stimulate new research to examine obesity as a life-course disease that demands a milieu of clinical and population-based responses, grounded in the proven concept of chronic care management.
Most people are unable -- or unwilling -- to make multiple trips to a medical center or their primary care physician's office for a year, two years, or more in order to participate in a supervised diet program.
That's why population-based approaches, centered in the places where people live and work, are gaining support among researchers, insurers, and the public.
Hundreds of employers, usually large corporations or public-sector agencies, have implemented wellness initiatives that incorporate programming designed to achieve lasting weight loss in employee populations.
They include components such as providing worksite fitness centers, weight-loss coaching, and incentives for participation in commercial weight-loss programs.
Some employers even facilitate access to medically supervised interventions through innovative benefit designs or other means.
New approaches to obesity management in clinical and population settings are grounded in two transformative ideas with significant policy implications -- prevention and chronic care management.
Successful implementation of these concepts throughout our healthcare system will be essential to any successful healthcare reform in the U.S.
Will the science of obesity management lead the way? We'll be watching.