Medscape One on One: The Surgeon General Takes the Lead in the Fight Against Obesity

Eli Y. Adashi, MD; Regina M. Benjamin, MD, MBA

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June 11, 2010

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Eli Y. Adashi, MD: Hello. I am Eli Adashi, Professor of Medical Science at Brown University and host of Medscape One on One. Joining me today is Dr. Regina Benjamin, the 18th Surgeon General of the United States, to discuss one of the most pressing public health issues faced by our nation: the obesity epidemic, coined in 2001 by former Surgeon General David Satcher.

The obesity epidemic has well earned its name. Since 1980, the prevalence of adult obesity in the United States has increased almost threefold to 34%. What's more, we hold the dubious distinction of being the world's fattest developed nation. Dr. Benjamin, who was senate-confirmed in October of 2009, wasted no time in addressing this issue. Her very first policy paper, "The Surgeon General's Vision for a Healthy and Fit Nation," released in January of this year prominently featured obesity, its causes, and its prevention.

Welcome, Dr. Benjamin. It is a great pleasure to have you with us.

Regina M. Benjamin, MD, MBA: Thank you.

Dr. Adashi: Obesity is variably defined by healthcare practitioners. How would you define it?

Dr. Benjamin: The most common thing that physicians and other clinicians use is the BMI, the relationship between height and weight. And that's been very popular.

Dr. Adashi: The so-called body mass index.

Dr. Benjamin: The fat body mass index. But you can have a body mass index that's outside of the range and still be perfectly healthy. For example, a very fit athlete might not fit in that range. However, I find that most people now are starting to move to the percentage of body fat. That is a much better indicator of where you really are. It's a little more difficult in the office and in the clinical setting to measure body fat. So we're trying to develop and find ways to measure the percentage of body fat.

As I like to say most of all, it's not the weight that matters. It's not the dress or the dress size or the weight on the scales. It's how you feel. It's your energy level, whether your endurance is there. Can you walk up a flight of stairs? It's that you're constantly improving where you are as an individual; that you're able to play with your kids, you're able to walk through the parking lot to enjoy yourself and live your life. And so that is really the measure that we need to use.

Dr. Adashi: Perhaps we can summarize it by saying that we are striving to reach a sense of wellness that is both physical and mental when we successfully combat obesity. Some physicians complain that they don't have enough time in the office to discuss obesity with their patients because they may not be reimbursed specifically for that service. Has the recent health reform act in any way addressed that issue? And for that matter, what efforts are we all trying to bring to bear on the obesity epidemic?

Dr. Benjamin: Reimbursement in general has been a major concern for office physicians and other clinicians. We don't get reimbursed enough to talk about diabetes, to talk to someone about their blood pressure medicine. But exercise is just as important. Exercise is medicine. It's just as important as that blood pressure pill. Often, the amount of exercise will determine how many blood pressure pills you take. So we have to look at it in the same light. We don't have the best reimbursement for any of those efforts.

As physicians, our ethical obligations as a doctor come first. Now the reimbursement issues are very real. And so we were very pleased when we passed the health reform bill, now the health reform law. In health reform is a basic idea of wellness and prevention; the basis of the entire law is wellness and prevention. We should start to see a lot more reimbursements of things that can move us toward prevention.

Even in that law, we have an entire counsel within the government focused on prevention and making us a healthier nation. Never before in our history have we really had a chance to talk about how prevention is important in our healthcare system. So I'm very optimistic and very positive about how this change in law is going to help us change our system from a sick system to a wellness system.

Dr. Adashi: So there is good reason to believe -- in fact, it almost is a certainty -- that with the new healthcare law, our ability to address obesity and related issues is enhanced and will be further enhanced by a variety of features that were built into the bill with an eye towards promoting prevention.

Dr. Benjamin: That's exactly correct. As the regulations and the policies are written, they will be written with those in mind.

Dr. Adashi: Some family physicians who see the entire family, women and children, have raised a concern about the lack of specific guidelines that would facilitate their role in dealing with childhood obesity. What are your thoughts about this issue? And what perhaps could we or should we, as a medical community, do about that?

Dr. Benjamin: We often have the growth charts to measure the height and weight of children as they grow. That helps us to know where to start talking about whether your child is inside or outside of that range. But we really do need to develop some better absolute guidelines as to how to approach this. I think that's an area for us to improve and to help our primary care physicians to have some tools in their hands when these patients walk into their office. I think that's a great place for us to start to develop.

Dr. Adashi: Something to look forward to and to work on as we proceed. Are there any other specific messages that you would like to deliver to healthcare providers that we haven't covered today?

Dr. Benjamin: Basically that we as healthcare clinicians and physicians and nurse practitioners and physician assistants, all the healthcare providers are trusted by our patients. They trust us that we are giving them good information. Because they trust us so much, we have an obligation to help them, particularly in these particular types of illnesses and diseases and disease processes.

Obesity and overweight, as we've said, are major issues, and resolving them will take behavioral changes. As health providers, we can facilitate change because people do trust us. When we tell them something, they respect it and they trust us.

The other thing is that clinicians have the opportunity to set an example, and we can do it ourselves. We can start setting examples for our patients and make them understand how important it is because we do it ourselves.

Dr. Adashi: Well said. On this note, a sincere thank you to our guest, Dr. Regina Benjamin, and to our viewers for joining Medscape One on One. Until next time, I am Eli Adashi.

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