I am returning from the Kaiser Permanente Care Management Institute annual meeting, where I (and impressively, 3 Kaiser Permanente members, as well as leaders from our affiliate, Group Health Cooperative) was an invited guest in one of the two tracks covering obesity prevention and treatment.
I was invited to bring my knowledge of social media / technology applications (in addition to several other experts in this area) and maybe because I think a little differently sometimes…I have an interest in this topic along with my colleagues in this post-EHR organization, because now it is about how the technology and other talents will be used to solve important problems. Exactly where we wanted to be.
Bill Dietz, MD, from the CDC, pointed out (and this is illustrated in the photo above) that Kaiser Permanente was one of the first health systems to engage in this health issue. I expected to learn a lot, and I very much did:
- The title of the post describes the situation William Dietz, MD, relayed to us in his presentation – the obesity rate for men and women has leveled off. I am not sure this piece of information has infiltrated our culture yet (and to read more, you can go to this New York Times Article and JAMA article) . This could be good news – this is what happened in 1964 before tobacco rates dropped dramatically in the United States. On the other hand, significant inequalities exist between racial/ethnic groups, and many believe (me too) that a reduction in rate without a reduction in inequality is not a reduction.
- I also learned that it is a myth that nothing can be done. Keith Bachman, MD, one of two national physician leads in obesity management, and Adam Tsai, MD, from University of Colorado, reviewed the data that there are effective approaches (behavioral, some pharmacologic) to reducing weight long term. The hurdle, therefore, is consistency in application. I learned that there are options and probably preference for community-based programs to do what medical care cannot do as cost effectively.
- We were joined by Matt Longjohn, MD, the Y’s (YMCA) first ever Senior Director for Chronic Disease Prevention, who talked about the Y’s highly publicized success in delivering community-based obesity programs based on evidence. He talked about how the Y is paid on two things : attendance in the classes, and weight loss. 2000 employers are now covering the program.
- I learned that there are hurdles in the way typical health care benefits are structured. The default emphasis in most of health care is medicalization, with coverage for the very obese for surgery, with less resources available for people who are overweight and obese.
- “Walk with a doc” – It’s no secret that I am a fan of the walking meeting (see: “The Art of the Walking Meeting“). I have always wanted to expand the concept to health care. And guess what, I didn’t have to, someone else did, notably other physicians in Kaiser Permanente. I learned more about this program and I love it tons. I think it is a great platform for bringing the benefits of walking to the patient-physician relationship, if it is done with great care and attention. I did a prototype in the early dawn up to the Golden Gate Bridge to prove to myself how much I love it.
Collaborative effort between the health system and the community, not just improvement, reduction of inequalities
When I spent time in England last year with groups from the National Health Service, I was enlightened again and again to the benefit/importance of the connection between the health care system and the social care system, which comes more naturally in that country.
I wrote recently about the Marmot Review and the thinking that it is not about improvement of health status, it is about reduction of inequalities of health status across the social gradient, and I can see the opportunity here to apply that thinking, too.
I’ll say I found that thinking in the room with me, and the desire to solve this for our members, the communities they live in, and all of society. I was not the smartest person in the room, which is a very good feeling.
There are things we can do. We have more abilities than we thought we did. There are people, organizations, and industries who will work with us, that’s us with a capital U.