• Archives

  • Jan27

    What Doctors Should Say to Patients Who Want to Lose Weight

    Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

    I was interviewed recently by the American College of Physicians about best practices for physicians who find it uncomfortable to speak with their patients who want to lose weight.

    The resulting article focused on “motivational interviewing”: I just think about it as how to speak with patients.

    Here is a video on motivational interviewing about weight loss. The actors are clumsy and the advice is imperfect (artificial sweeteners are not the solution, there is no motivation elicited, the patient probably feels deprived, and the doctor is still directing instead of listening well). But this type of conversation is a first step.

    The real problem is that people don’t know how to do what physicians (may) tell them to do.

    The lack of training for physicians about what to say and how to say it doesn’t help. I got 4 hours of nutrition in medical school, and 2 hours in cooking school. None were about obesity.

    Finally, most physicians aren’t paid to have these conversations. They need to code a visit about weight management as something else, so they can be paid. I hope this changes with health reform. And it may.

    Motivational interviewing is a good tool–with enough time, compensation, evidence-based content and practice it will help. We can do it: POLST has done it for care near the end of life. Obesity could actually be easier.

     

  • Aug31

    The Business Case for Prevention

    Posted in: Aging and Costs of Aging, Wellness and Health

    There is a great business case for prevention.  And the government is making the argument, and putting our money, towards it.

    Starting 2011, small companies—those with 100 employees or fewer, and no existing wellness program in place–will be able to get grants for up to five years to establish employee wellness programs. With a 30% credit.

    Companies also can establish employee rewards programs, with an up to 50% credit by the government.

    But what are the criteria? How to apply? Where is the grant application? Not posted, yet.

    Many studies say corporate wellness programs show a positive return on investment (ROI). A study of 56 worksite health promotion programs showed, on average, 32 percent less workers’ comp/disability claims costs.

    A 2010 Harvard Study of wellness programs found
    *$2.73:1 savings-to-cost ratio for absenteeism
    *$3.27:1 savings-to-cost ratio for health costs

    All from the Patient Protection and Affordable Care Act. Here is a timeline summary through 2015, courtesy of the Kaiser Foundation, about what to expect. Fasten your seat belt!

     

  • Aug27

    The Coming of Prevention: What’s Covered

    Posted in: Aging and Costs of Aging, High Cholesterol, Wellness and Health

    Get ready for a boom in prevention. Many benefits will be covered. But which?

    Health plans established on or after Sept. 23, 2010 will need to cover preventive services rated “A” or “B” by the U.S. Preventive Services Task Force. Ditto Medicare/Medicaid by January 1, 2011.

    Which services are those for You? Fill in the quick blanks below: it shows “A” and “B”.

    No copays, deductibles and coinsurance amounts will be due. That’s for

    • Mammograms, colonoscopies and other cancer screenings.
    • Blood pressure, diabetes and cholesterol screening.
    • Lifestyle counseling (quitting smoking, losing weight, eating better, treating depression and reducing alcohol use).
    • Counseling and screening for healthy pregnancies.
    • Flu and pneumonia vaccines
    • Regular well baby and well child visits

    Older private employer plans are exempt or grandfathered, if they don’t change their plans. But most will. 70 percent will probably lose their exemption or grandfather status by 2013.

    Next: grants for employee wellness.

     

  • May11

    Marching Orders for Docs, Hospitals: The White House Child Obesity Report

    Posted in: Wellness and Health

    Today, the White House Task Force on Childhood Obesity has released its recommendations and report. Of course, it needs a roadmap: recommendations without funding or teeth just set the agenda. But for doctors, hospitals and insurers, the assignments are clear.

    *Doctors should
    a. calculate BMI, beginning at age 2
    b. tell parents how to keep kids slim (this is worth a lot, as most MDs are frustrated and feel ineffective)
    c. prescribe, on a Rx pad, healthy active living

    *Insurance should cover assessing, preventing and treating overweight and obese kids.

    *Medical schools, associations and health care systems should train and teach pediatric obesity prevention and treatment.

    How will this work? The NCQA, which monitors quality for health care plans using a tool called HEDIS, will track rates of BMI assessment, nutrition and physical activity counseling. And payment dollars *may* follow. What a big If!

    Childhood obesity increased by 10% between 2003 and 2007. 16.4% of U.S. kids are obese and 31.6% overweight.

    The incentives have been not to write recipes on prescription slips, or prescribe free play. That takes training and time which most health providers don’t have and don’t get paid for.

    But physicians and hospitals are no different than other workers: they do more of what they are paid and trained to do. Let’s move!

     

  • Jan19

    Grand Rounds: Can Food Be Health Care?

    Posted in: Wellness and Health

    When Food as Medicine Grand Rounds appeared 3 years ago, it was a toddler, pulsing with Inspiration and Experimentation.

    Now, it’s skipped adolescence and it’s going to Washington! But as Jake Sully notes: “…all energy is borrowed; at some point you have to return it.”

    Weight Loss
    @precordialthump unveils his Utopian College of Emergency for Medicine (UCEM) regimen for combating post-Christmas corpulence: ME (more exercise) and ELF (eat less food). Actually, EDF (E Different F).

    Healthline’s Nancy Brown dissects the data: a medium movie popcorn and soda gives 1610 calories and 60 grams saturated fat. BYO, please…a theme for 2010.

    Chef Paul Lynch cooked a week’s meals for diabetic Mrs. Ippolito in an Oldways Whole Grains Makeover for a Grand Prize Winner. No doubt a break from higher GL carbs.

    DiabetesMine offers much needed relief from the “daily manual pancreas” with an artificial pancreas, which is one way around all those Cheetos.

    And then there are adolescent females with Type-1 diabetes who have a two to four-fold higher incidence of eating disorders. Insulin omission is their weight loss MOA. Scholarly Terri Schmitt shows us why.

    Contrast that with MedLibLog’s touching food-for-thought post on childhood obesity, and the proper role of unsaturated fat in food.

    Money
    David Williams’ Business Blog smartly dissects the Cookie Diet (and its reported $18m 2008 revenues).

    Henry Stern can’t believe that you can donate blood and get beer, and wonders if pot (brownies?) is next.

    Reason sees low-methionine foods as both key to longevity and a potential pot of gold. That’s lots of peppers and berries, btw. Wouldn’t that be amazing?

    Pleasure
    Fitness Fixer’s Dr Bookspan, bless her heart, takes pleasure in the rhythm of cooking and giving and gardening.

    Theresa at thefoodhunter finds literal calf strength in learning to cook local, better than any trainer. You go girl.

    Dr Bates’ personal trainer is loyal, handsome and photogenic. Yours can be too.

    Eve Harris manages to tie together Food TV’s Alton Brown’s volitional weight loss and integrative oncology in a healthy piece of her mind. Wish there were more…she really gets it.

    Reform
    With photos of Martha Stewart and Dan Barber in the open air of a New York summer event, Eddie C’s beautiful story going from food activist to a prestigious botanical institution shows where reform could head. Grow more of your own. Get sick less.

    That poetry is complemented by Medical Whistleblower and his smart and funny Health Care Reform Reformed Christmas Carol in Rhyme.

    Colorado health insurance insider (the only U.S. state <19% obesity) states: “the main reason health insurance premia are out of control: we’re too fat and we overuse our healthcare system.” Ouch. Off the couch!

    Each TV hour watched increases the CVD death rate by 18%, according to Happy Hospitalist. Watching, not being on:). Though as hard as Dr Oz is working, I wonder.

    Barb at Florencedotcom suggests viewing the well-referenced AHRQ Patient Safety site.

    But where are food allergens, chemical contaminants (no BPA, via ChefMD’s blog) in hospital food, no cheeseburgers after bypass, and soda as off-limits for pediatric patients? Food as medical error is not on the safety radar. Yet.

    Follow Dr Gawande: his last New Yorker piece was about farming. And food.

    N.b. I liked other submissions too, though they were not about food: the heroicism of clinicians volunteering in Haiti (Inside Surgery); docs leaving medicine (Dr Gwenn); fighting tamponade (with dayglo photos) from Bongi; social media in Aussie hospitals from @sandnsurf; the musings of distractible internist Dr Rob; and epinephrine auto-injectors from AllergyNotes.

     
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