Your message to patients: Supersize, shorter life

Patients must understand that obesity impacts quantity, as well as quality of life.

Editorial. Feb. 17, 2003.

We have become a nation of supersizers. A study in the Jan. 8 Journal of the American Medical Association found that food portions at fast-food restaurants and at home have gotten bigger since 1970. The study's results are more bad news for physicians fighting what is an uphill battle of the bulge.

Obesity is an epidemic. Previous JAMA studies indicated that two in three U.S. adults are classified as overweight or obese, up from fewer than one in four in the early 1960s.

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Obesity ranks second only to tobacco in causing premature death. It has been linked to high blood pressure, high cholesterol levels, heart disease, diabetes and arthritis.

Yet physicians often find themselves in an exam room with overweight patients who don't seem particularly concerned about this litany of health problems and, as a result, are even less inclined to undertake a diet and exercise program to shed unhealthy pounds.

But thanks to a recent study, once again in JAMA, physicians may finally have a compelling way to explain the situation and make even the most apathetic obese patient pay attention -- by expressing obesity's damage in years of life lost.

Researchers' findings, in a study that took race and gender into account, suggest that obesity can have a profound and quantifiable effect on the life span. The risk of increased years of life lost is greatest when the onset of obesity is at a young age.

White men between 20 and 30 years old with a body mass index greater than 45 face a maximum of 13 years of life lost; for white women that number is eight. Obese blacks at younger ages face a maximum loss of life of 20 years for men and five years for women. The study did not find that obesity causes significant years of life lost for black men and women older than 60.

While the most startling years of life lost numbers are for the very obese, the study shows that even a moderate amount of excess weight has a negative effect on life expectancy. Furthermore, as the degree a person is overweight increases, an accompanying shortening of life span occurs. This information may be just what physicians need to add muscle to weight discussions with obese patients. And it is also a stark reminder that these discussions must take place -- the earlier in life, the better.

Yet it is well known that physicians face obstacles in initiating this discussion -- the least of which may be the reluctant patient. Reimbursement rates for patient weight management and counseling vary from insurer to insurer. Few health plans pay for separate office visits to discuss the matter. This despite the fact that their emphasis on shortening patient encounters also makes it difficult to find time to discuss options for weight control during regular office visits. Effective weight-loss counseling takes several visits.

The AMA has urged managed care organizations and other third-party payers to recognize obesity as a complex disorder. The Association has urged the appropriate federal agencies to work with organized medicine and the health insurance industry to develop coding and payment mechanisms for the evaluation and management of obesity. The surgeon general estimates that public-health costs attributable to being overweight or obese are now about $117 billion per year. It is time for insurers to recognize that an immediate outlay for weight control now will save them money later, and they should buy into uniform reimbursement policies.

But even without such progress, physicians must engage with patients in discussions about their weight. The supersize patient needs to understand that obesity is not only a matter of diminished quality of life, but of shortened length of life as well.