|By Kyu Rhee, MD, MPP, FAAP, FACP, Former Chief Public Health Officer, Health Resources and Services Administration, U.S. Department of Health and Human Services|
As an internist and pediatrician with frontline experience in community health settings, I’ve witnessed the soaring prevalence of obesity and overweight in recent decades. And as a federal health officer, I recognize that our health system is not yet prepared to address this public health crisis. Our biomedical research paradigm has long focused on going from bench to bedside. But unlike many conditions that can be treated with medication, obesity is a multifactorial problem that is closely tied to social and community factors. To deal with it effectively on a population level, we must widen our horizons and think more about going from bench to curbside. So far, however, we have only just begun to move in this direction. We face an urgent need to help health care providers and community stakeholders across a variety of sectors develop new strategies for promoting healthy weight.
Clinicians can be catalysts for change in dealing with obesity. They know the data, they hear the stories, and they see the limitations of our knowledge and capabilities. In many settings, obesity is a consistent, recurrent problem that affects two-thirds of patients seeking care. Often, however, clinicians are befuddled by the problem and simply don’t know what to do. Typically, half of a 15-minute office visit is taken up by documentation. With just 7 minutes to address a broad range of health issues, a clinician can’t properly address obesity.
A crucial first step is to give clinicians tools to intervene and provide appropriate counseling about healthy weight. We must reinforce the importance of screening patients for obesity, because what you measure determines what you do. Some clinicians will say, “What’s the point of screening? I can’t do anything about it.” But if you don’t measure it, it’s hard to do something about it. So we simply have to screen. At the Health Resources and Services Administration (HRSA), we recently announced that we expect all of our health centers to measure body mass index routinely and to provide obesity prevention counseling for all patients at risk. This will help us address this health problem among the millions of uninsured, isolated, medically vulnerable individuals served by HRSA.
The next step calls for new approaches that extend beyond the clinical setting. Clinicians know that they can’t deal with obesity on their own, and that they need to work with the entire health care team—the nurse, the community health worker, the nutritionist, the physician assistant, and the front-desk staff. Beyond that, we need to think outside the health care environment and team up with educators, employers, faith-based leaders, and other “trust brokers” in the community. By developing relationships across sectors, we can develop a coordinated approach and create environments in which healthy behavior is not an active choice that people must make, but the default choice.
One way to support a transdisciplinary approach that involves community health workers and other professionals is to urge providers to give patients a prescription for healthy behaviors. When I worked at the Upper Cardozo Health Center in Washington, D.C., we had teen health promoters who would talk with young patients after office visits and refer them to a local youth center or other community facility. Later, at the Baltimore Medical System, grant programs helped us look beyond the daily frustrations of frontline clinical care, think more strategically, and build partnerships with academic institutions, health insurers, and local foundations that were looking for innovative ways to deal with obesity and related health problems. For example, one large grant allowed us to set up a community health worker intervention program aimed at changing health behaviors among diabetics.
In my current role at HRSA, I hear about innovative ways to shake up people’s thinking about preventing obesity. These range from educational handouts, school initiatives, and worksite programs to social networking tools, community campaigns, and public policies. For example, a Baltimore program lets people in safety net communities order healthy foods that are delivered from farms to nearby libraries, hospitals, and community centers. If this approach works in Baltimore, why not try it in other cities? Clearly we must do a better job of learning from each other and implementing good ideas in other settings.
Innovation requires change, and it’s not easy. You have to convince a lot of resistors, late adopters, and critics of change. That’s why HRSA announced in September 2010 that it was funding a Prevention Center for Healthy Weight, which is designed to identify and disseminate new approaches for preventing obesity in children and families. Aligned with the First Lady’s “Let’s Move” initiative and managed by the National Initiative for Children’s Healthcare Quality in Boston, the center is launching the Healthy Weight Collaborative, an 18-month project that will identify, test, refine, and share promising community-based and clinical interventions for preventing and treating obesity.
As we seek to promote healthy weight innovations, we need to keep in mind that different approaches may be needed in different settings. Obesity is much more prevalent and destructive in medically underserved and vulnerable populations, whether they are identified by socioeconomic status, race and ethnicity, or geographic setting. This makes the need for new approaches even more compelling.
Moreover, it’s clear that any approach to the obesity epidemic needs to be family centered and focused especially on children. Obesity in childhood is a precursor to a lifetime of obesity and all of the illnesses associated with it, from diabetes to heart disease to arthritis. From an economic perspective, pushing for prevention in childhood is our best investment.
Ultimately, we have no choice. We have to face this public health crisis, just as we’ve faced others. With support from the Affordable Care Act, we have an opportunity to transform our health system and focus it more on prevention, going to where health begins, and not just where health ends.
About the author
Kyu Rhee, MD, MPP, FAAP, FACP, is the former Chief Public Health Officer of the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services. Dr. Rhee is board-certified in internal medicine and pediatrics. Previously, Dr. Rhee was director of the Office of Innovation and Program Coordination at the National Institutes of Health’s National Center on Minority Health and Health Disparities. Before that, he was chief medical officer of Baltimore Medical System, the largest network of Federally Qualified Health Centers in Maryland. He also served as a National Health Service Corps Scholar and as medical director at the Upper Cardozo Health Center in Washington, D.C.