Should doctors refuse to treat obese patients?

IN BRIEF: Doctors are not required to treat obese patients who won’t do anything to lose weight but the problem is more than reminding patients they need to get exercise and drop pounds. One study found that only 50 percent of patients follow the instructions associated with taking their medication, and even fewer implement necessary lifestyle changes suggested by their doctor. This is leading to excessive costs to out healthcare system and something needs to be done.

Susan knew she needed to lose weight, especially when her doctor told her that her A1C indicated that she was prediabetic. Three months later, she found out that she had actually gained another 15 pounds. Her doctor read her the riot act and told her that she either needed to lose weight or find another doctor. Fair?

The Times said “one in three Americans is obese, a rate that has been steadily growing for more than two decades, but the health care system — in its attitudes, equipment, and common practices — is ill-prepared, and its practitioners are often unwilling, to treat the rising population of fat patients”. There are many reasons why patients get obese . The NHS reportsobesity is generally caused by eating too much and moving too little. If you consume high amounts of energy, particularly fat and sugars, but do not burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat“.

Dr. Louis J. Aronne, an obesity specialist at Weill Cornell Medicine says “physicians need better education, and they need a different attitude toward people who have obesity”. “They need to recognize that this is a disease like diabetes or any other disease they are treating people for.” But what about patients who make no effort to lose weight?

The statistics on obesity and chronic health conditions are well documented but it’s become politically incorrect to take about someone’s weight. Some health insurers require that HCP’s notify patients they are obese and that they are in danger of chronic conditions but that’s not enough. 42% of Americans gained weight while stuck at home during the pandemic. On average, a survey found, people gained 29 pounds, while Millennials reported the highest average weight gain at 41 pounds. This is going to cost us ALL.

Physicians don’t have the time to really talk to patients about their weight and lack of exercise. It’s a difficult conversation but one that needed to be had sooner rather than later. Obese patients cost all of us more money in healthcare costs, yet our healthcare system ignored this problem. The CDC estimates that the annual cost of obesity in the United States is a staggering $147 billion, with obese patients accruing almost $1,400 more in health care costs than Americans with a healthy weight. Medicare and Medicaid patients specifically cost $61.8 billion per year!

The Treat and Reduce Obesity Act (H.R. 1530/S.595), a bill that Congress has been considering for nearly a decade, currently has Congressional support from 185 co-sponsors in the U.S. House of Representatives and Senate (House-168, Senate-17). This is great news and reflects very strong support! However, despite the momentum the bill has gained throughout the years, the Treat and Reduce Obesity Act (commonly known as TROA) has yet to come up for a committee or floor vote since it was first introduced in 2013. It needs to be passed NOW but even this won’t be enough.

Insurers should be providing obese patients with wearable devices, like a Fitbit or Apple Watch, to track the patient’s activity. Patients who don’t have a medical reason for gaining weight should be counseled about diet and exercise, and if that doesn’t work, their insurance premiums should be increased.

 The Dietary Guidelines for Americans states that the average American diet consists of excess sodium, saturated fat, refined grains, and calories from solid fats and added sugars1. Furthermore, the guidelines state that Americans eat less vegetables, fruits, whole grainsdairy products, and oils than recommended. In another words our diet is killing us. It’s time to act before it’s too late.

Should doctors refuse to treat obese patients?