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Kaiser Permanente is a different kind of health system, as we all know. It has been a major funder of the HBO Series Weight of the Nation — reviewed by Kristin Molven in a companion piece on THCB today. Matthew Holt interviewed Raymond Baxter who is Kaiser’s Senior Vice President of Community Benefit, Research and Health Policy about the role KP plays in community and policy issues, and what we know and what we should can and should do about obesity.
Kristin Molven is a medical student at The University of Olso. She is currently a student in the Norwegian Entrepreneurship Programme at UiO and UC Berkeley, and is interning at Health 2.0.
HBO’s documentary series The Weight of the Nation made me sad. I was left with the feeling that the wealth my parents have provided and all prior generations’ good intentions to make it easier for us to gather food and survive, and the technologies they developed to make our lives easier now are destroying us. My generation is short-circuiting. When looking to satisfy our needs, we meet no obstacles, no resistance. Everything is readily available to us, and we are fast-forwarding towards the negative consequences of constant access. And the food industry makes a profit off our misfortune.
The Weight of the Nation campaign consists of four main films, a dozen of extra short films and an accompanying book and website. It was launched in May by HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention, the National Institutes of Health, Michael & Susan Dell Foundation and Kaiser Permanente.
The campaign abandons the idea that obesity is an individual shortcoming or to results from a lack of self-control. Instead the campaign holds society responsible for today’s weight problems. Come to think of it, this is not unreasonable as humans have the same mental capabilities as former generations that were not obese. What has changed is our behavior and surroundings. Physical activity has been engineered out of our daily routine, while unhealthy tempting food has become cheaper and more accessible. Let’s not pretend that our grandparents had higher moral standards by avoiding sugar and fat and took the stairs instead of the elevator. They surely would have made the same choices as us if they had the chance. Given that nobody intends to become overweight or obese, we have designed a society where it is just too hard for most of us to maintain a healthy weight.
Consequences and Choices, the two first films of The Weight of the Nation series, examine the physiology and pathology of weight gain and obesity.Continue reading…
Many observers believe that the economic realities of the food supply chain contribute to public health problems from heart disease to diabetes. A look at the disturbing economics of the Cheeseburger economy from the Center for Investigative Reporting.
Via The Center For Investigative Reporting.
See Also: The Economist Big Mac Index
Worried about the potential personal and economic costs of obesity? Never mind. It’s time to view obesity as a business opportunity.
As the press release for a new research report from Bank of America Merrill Lynch, Globesity—The Global Fight Against Obesity, points out:
“Increasing efforts to tackle obesity over the coming decades will form an important new investment theme for fund managers…Global obesity is a mega-investment theme for the next 25 years and beyond…The report…identifies that efforts to reduce obesity is a “megatrend” with a shelf-life of 25 to 50 years…BofA Merrill Lynch analysts across several sectors have collaborated to identify the sectors and companies developing long-term solutions.”
Given the worldwide increase in obesity, its high prospective costs, and the ever-present threat of government regulation, the report identifies more than 50 global stocks that provide investment opportunities for fighting “globesity.” These fall into four categories:
Yesterday, New York City Mayor Michael Bloomberg announced a ban on sales of sugary drinks larger than 16 ounces in restaurants, delis, sports arenas, and movie theaters.
The reactions have been ferocious, and not only from the soda industry, which placed an ad in the Times (see below).
The New York Times also weighed in with an editorial arguing that the mayor has now gone too far and should be sticking to educational strategies.
Alas. If only educational strategies worked. But they do not.
We know this from what it took to discourage people from smoking cigarettes. We also know this from research on eating behavior. This shows that it doesn’t take much to get people to eat too much.
Just barrage us with advertising, put food within arm’s reach, make food available 24/7, make it cheap, and serve it in enormous portions.
Faced with this kind of food environment, education doesn’t stand a chance.
That’s the point the Mayor’s proposal is trying to address, however clumsily. After all, a 16-ounce soda is two servings.
Sugary drinks—especially large ones—make sense as a target for a portion size intervention.
As the next act of the Massachusetts health care drama plays out on Beacon Hill, the same characters return to the stage with a tired script. The ostensible hero of the production, the patient, is left to watch the tragedy from the back row.
Legislation being debated on Beacon Hill ignores patient-centered health plans and health savings accounts, or HSAs, which are lower-premium insurance plans that direct pre-tax dollars into a bank account to cover an individual’s current health care and save money for future medical expenses. An HSA is the most direct way to engage patients in the health system. They cover out-of-pocket medical, dental, and vision expenses, are fully portable, and owned by individuals for their entire lives.
Unlike the self-interested solutions of insurers, providers, and government, HSAs are a proven way to contain the cost of care.
Nationwide, 11.4 million people of all ages and income levels purchase patient-centered plans, up over 250 percent from 2006, when they were created. Among HSA account holders, fully half earn less than $60,000; almost three-quarters have children; and about half are over 40.
Safeway, one of America’s largest supermarket chains, rolled out a patient-centered plan in 2006; per capita health care spending shrank 13 percent, and costs remained flat for four consecutive years.
Safeway’s plans have reduced employee obesity and smoking rates to roughly 30 percent below national averages. This health dividend is priceless as 70 percent of health care costs are directly related to lifestyle decisions.
I saw a gentleman in my office recently. He was having severe pain radiating from his lower back, down to his calf.
I was about to describe my plan to him when he interrupted me saying, “I know, Doc, I am overweight. I know that this would just get better if I lost the weight.” He hung his head down as he spoke and fought off tears.
He was clearly morbidly obese, so in one sense he was right on; his health would be much better if he would lose the pounds. On the other hand, I don’t know of any studies that say obesity is a risk factor to ruptured vertebral discs. Besides, he was in significant pain, and a lecture about his weight was not in my agenda. I wanted to make sure he did not need surgery, and make him stop hurting.
This whole episode really bothered me. He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him. He was living in shame. Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character. After all, losing weight is as simple as exercise and dietary restraint, right?
Perhaps I am too easy on people, but I don’t like to lecture people on things they already know. I don’t like to say the obvious: “You need to lose weight.” Obese people are rarely under the impression that it is perfectly fine that they are overweight. They rarely are surprised to hear a person saying that their weight is at the root of many of their problems. Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.
Last year Priceline founder Jay Walker bought TEDMED –a conference that licenses the TED style and brand but is separately owned from its famous cousin. While there was some fun controversy about the sale, Walker made two key decisions. First he moved the conference from San Diego to Washington D.C. to try to get it more central to the health policy debate, and second he initiated a set of 50 Great Challenges from which the community voted a top 20. These are things like tackling the obesity crisis, getting transparency in medical research, training next generation of leaders and more.
Much of the fun and high production value entertainment from previous years stayed, but there was a new sense of urgency in the air concerning making changes from a top down and bottom up level in the way policy works for science and technology. There was rather less information technology than in years past and more emphasis on things like training of physicians, food policy, and basic science.
Like TED there’s a strong sense of celebrity at TEDMED with entrepreneurs like Walker and buddy AOL founder Steve Case on hand, mixing with newscaster Katie Couric and volleyball pro Gabby Reece. There’s also an interesting (and we hear not cheap) sponsorship model with the exhibit hall being more about zones for discussion rather than tradeshow demos. We like Philips sleep discussion and Booz Allen Hamilton’s discussion area.
One of the most common ideas in the whole healthcare financing discussion is a moral one. Why, people say, should my taxes and my healthcare premiums go to take care of the huge medical problems of people who don’t take care of themselves? As one commenter on THCB put it: “…self inflicted injuries to not be covered at all, ideally. If someone drinks their liver away I don’t think we should all have to buy them a new one. Same for smoking.”
This is a common idea, one that seems logical and right on the surface. But there are four assumptions built into it, all four of which have problems:
1) That the “self-inflicted injuries” that people commonly identify (smoking, drinking, other addictions, obesity) actually are major predictors of cost.
2) That we can clearly differentiate “self-inflicted injuries” from other medical problems
3) That to the extent that they are actually “self-inflicted,” the patient could just stop doing them if they just had enough gumption, or enough something.
4) That if our goal is to cut unnecessary medical costs, refusing medical coverage would cut costs.
But each of these four is problematic.
1) The best predictors of medical costs are not smoking, drinking, or obesity, but depression and stress. (“Association Between Health Risks and Medical Expenditures“) So trying to dis-insure “self-inflicted injuries” might miss the target of lowering healthcare costs.
2) Trying to decide what is “self-inflicted” and what is not presents a major problem. A friend has a lifelong condition that gives him excruciating pain. He has struggled manfully (and successfully) against addiction to booze and painkillers to ameliorate his pain. He has always felt bitter toward his father because his father was addicted to booze and painkillers. He recently realized that his condition is genetic, and guessing from some symptoms he observed, realized that his father was fighting the same excruciating pain. His attitude toward his late father changed instantly.
There are times I wish I had a macro for the beginning of a post on obesity. Some way to say obesity is bad, obesity is prevalent, and nothing seems to work. You know the drill.
But there’s a new study in Health Affairs that was surprisingly promising:
We performed three related field experiments at a single fast-food restaurant to determine whether these reported sentiments could be translated into a strategy to alter calorie consumption. All of the experiments addressed three important elements of eating behavior.
First, do people spontaneously request smaller portions—that is, even if smaller portions are not specifically noted as an option on a menu or signage? Second, do people accept explicit spoken offers to take smaller portions in order to reduce calories? Third, does taking a smaller portion of one meal component lead to indulgence in other meal components, so that the calorie “savings” from downsizing are immediately lost?
Each experiment addressed an additional question. In experiment 1, we explored whether offering a nominal (twenty-five-cent) discount for downsizing would result in more customers’ accepting the offer than offering no discount. In experiment 2, we examined whether offering an opportunity to accept a smaller portion would be more effective than providing calorie labels in encouraging moderation. In experiment 3, we investigated whether downsizing appealed only to customers who would otherwise have thrown away uneaten food, thereby affecting calories ordered but not calories consumed.
Let’s start with experiment 1. First, they measured how many customers would spontaneously request a smaller portion of a high-calorie, high-starch side dish. Not surprisingly, only 1% did. But if customers were asked, on the other hand, one third accepted the offer, regardless of whether a discount was offered. What’s more, those that did downsize did not compensate by up-sizing any other portions of the meal. Those that downsized ordered significantly fewer calories, 100 fewer on average.
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