A New Patient-Centered Action Agenda calls for people with obesity to have the same rights and access to care as people with other chronic diseases

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July 7, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC— The National Consumers League (NCL) today released A New Patient-Centered Obesity Action Agenda: Changing the Trajectory of Obesity Through Patient Empowerment, Health Professional Intervention and Supportive Government Policies, a new report with a blueprint to change how Americans think about obesity, empower people with obesity to get the best care, and afford those with obesity the same access to care as adults with other serious chronic diseases.

Issued as a call to action, the report was prepared in consultation with a panel of leading obesity specialists as a roadmap for overcoming one of the difficult challenges affecting US adults now living with obesity: despite significant advances in the understanding and treatment of obesity, only 10 percent of people with obesity get help from medical professionals,[1] meaning the disease remains largely undiagnosed and undertreated. Accordingly, only 30 million[2] of the estimated 108 million adults living with obesity[3] have been diagnosed with the disease and only around 2 percent of those eligible for anti-obesity medications have been prescribed these drugs.[4]

The consequences of undertreatment affect virtually every aspect of the healthcare system. Obesity not only has a negative impact on almost every aspect of health and well-being, but it worsens the outcomes of over 230 obesity-related chronic diseases, from type 2 diabetes and heart disease to some forms of cancer.[5] Accordingly, obesity is responsible for an approximately 300,000 premature deaths each year[6] deaths and costs the U.S. economy an estimated $1.72 trillion annually in direct and indirect costs.[7]

“Although obesity is one of today’s most visible public health problems, it is often ignored and discounted as a serious disease, resulting in a health crisis that has only worsened with time,” said
Sally Greenberg, NCL’s Executive Director. “This report focuses attention on the numerous public perception, provider and policy-related factors that preclude Americans with overweight and obesity from getting effective treatment and must be addressed if obesity outcomes are to improve in the US.”

To change the trajectory of the obesity epidemic, the report calls for a national mobilization to overcome the “human” factors– incorrect beliefs about the cause and treatment of obesity, prejudice towards people due to their size, lack of training for health providers, access barriers, and outdated government policies – that continue to prevent Americans from seeking and obtaining obesity care. Towards this end, NCL’s patient-centered action agenda identifies nine priorities for action:

  1. Redefine Obesity for the American Public as a Treatable Chronic Disease

Although the American Medical Association classifies obesity as a chronic disease requiring treatment, three-quarters of Americans believe obesity results from a lack of willpower. Thus, redefining obesity as a treatable chronic condition will provide a new context for health providers and patients to have a positive discussion about weight, leading to more people getting diagnosed and treated.

  1. Adopt Patient-First Language for Obesity

Unlike other chronic diseases where health professionals use people-first language that puts a person before a diagnosis, practitioners routinely use terms to describe obesity that can be off-putting and demoralizing. To change this situation, the National Consumers supports the agenda of the People-First Initiative launched by the Obesity Action Coalition, which advocates for widespread adoption of people-first language by practitioners in all healthcare settings.

  1. Make Combatting Weight Stigma a National Priority

Studies show that 40 percent of healthcare professionals –physicians, nurses, dietitians, psychologists and medical students – admit to having negative reactions based on a person’s size.[8]Addressing this pervasive problem requires a unified national initiative that makes the impact of weight stigma “real” for clinicians and the public and disseminates the latest information to health providers on strategies to reduce weight stigma.

  1. Elevate the Need for Physician Training in Obesity

A recent study of 40 US medical schools finds that 30 percent of these institutions provide little or no education in nutrition and obesity interventions while one third of schools reported no obesity education programs in place.[9] These findings underscore the urgency for US medical schools to change their priorities and develop curricula that comprehensively addresses the disease of obesity.

  1. Establish Excess Weight as a Vital Sign

Besides body temperature, blood pressure, heart rate and respiration, health providers routinely measure height and weight at each visit. Thus, if healthcare professionals were to calculate and provide patients with their Body Mass Index (BMI) at the time of the office visit, practitioners could have a tool to discuss excess weight when patients are most receptive to discussing their health status.  It is recognized that BMI is a crude measure and not the sole predictor of obesity but when combined with patient-friendly information that explains the level of weight and options for treatment, this interaction could initiate a positive, respectful conversation about obesity care.

  1. Provide the Tools for a Doctor-Patient Dialogue on Excess Weight

A major reason primary care providers (PCPs) are reluctant to provide obesity counseling is the lack of informational tools to have conversations with patients about their weight status and care options. Therefore, a unified effort to make available to PCPs evidence-based, patient-friendly content on obesity will facilitate a better dialogue between clinicians and patients and promote shared decision-making.

  1. Establish Coverage of Obesity as a Standard Benefit Across Insurers and Health Plans

Although employers and insurers are starting to cover treatment options for obesity in employee benefit packages, too many people continue to be denied coverage or face access barriers, such as step therapy and prior authorization, that delay treatment. Improving obesity outcomes therefore requires supporting legislative efforts, like the “Safe Step Act” that would require group health plans to provide an exception process for step-therapy protocols. It also necessitates collaboration among payers, providers, policymakers, and advocates to establish a standard, affordable benefit for the prevention and treatment of obesity that applies across plan types and payers.

  1. End Outdated Medicare Rules That Exclude Coverage for Necessary Obesity Care

Today, the many millions of Americans enrolled in the Medicare program are denied safe and effective obesity treatment due to outdated Medicare Part D rules that exclude coverage for FDA-approved obesity drugs and Medicare Part B policies that places undue restrictions on intensive behavioral therapy by allowing only primary care providers to deliver IBT and severely restricting the physical locations where this care can occur. Congress has the power to change this situation, which is why NCL has joined with the obesity, public health and nutrition communities is pressing for swift passage of the Treat and Reduce Obesity Act (TROA). The proposed legislation would expand Medicare coverage to allow access to IBT from a diverse range of healthcare providers while ending the exclusion for new anti-obesity medications that are improving the standard of care for adult Americans with obesity.

  1. Create a Patients’ Bill of Rights for People with Obesity

For too long, people with obesity have been stigmatized, discriminated against, and have faced significant hurdles and burdensome requirements to receive care. Changing this situation will require giving people with obesity the knowledge, skills and confidence to be advocates for their best obesity care. Therefore, NCL’s patient-centered obesity action agenda calls for the creation of a Patients’ Bill of Rights for People with Obesity based on the recognition that obesity is a treatable disease and everyone with obesity deserves the same level of attention and care as those with other chronic conditions.

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About the Report

To prepare the report, NCL partnered with the Obesity Care Advocacy Network (OCAN) to host a roundtable discussion in December 2021where public health specialists, leading professional societies, the minority health field and the obesity policy community assessed the state of the science on obesity today, the scope and cost of the disease in the US and the major barriers impeding quality obesity care with special attention to the “human” obstacles that keep people with obesity from seeking or obtaining treatment. Additionally, NCL conducted a literature review to gather additional insights, especially regarding how to change how people with obesity see themselves, so they become empowered to advocate for their care as patients with a chronic disease. Based on this assessment, NCL drafted the report, which was vetted by experts participating in the roundtable, and developed the policy recommendations included in the Patient-Centered Obesity Action Agenda.

 

About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

 

[1] Stokes A, et al. Prevalence and Determinants of Engagement with Obesity Care in the United States. Obesity. Vol. 26, Issue 5; May 2018, 814-818

[2] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[3] Hales CM,, et al. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. Centers for Disease Control and Prevention. NCHS Data Brief. No. 360. February 2020.

[4] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[5] Obesity Care Advocacy Network. Fact Sheet: Obesity Care Beyond Weight Loss

[6] Allison DB, et al. Annual deaths attributable to obesity in the United States JAMA 1999Oct 27 282(16)1530–8.

[7] Milken Institute (October 2018), “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight.”

[8] Fruh SM, et al. Obesity Stigma and Bias. J Nurse Pract. 2016 Jul-Aug; 12(7): 425–432.

[9] Butch WS, et al. Low priority of obesity education leads to lack of medical student’ preparedness to effectively treat patients with obesity; results from the U.S. medical school obesity education benchmark study. BMC Med Educ 20, 23 (2020)

NCL to USDA: Portion control must be key strategy for fighting America’s highest-ever obesity rates

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July 11, 2019

Media contact: National Consumers League – Shaunice Wall, MS, RD, shaunicew@nclnet.org, (202) 835-0331, Carol McKay, carolm@nclnet.org, (412) 945-3242, or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC—The National Consumers League (NCL) presented oral comments to the USDA’s Dietary Guidelines Advisory Committee today in Washington, DC, urging the committee to focus on portion control as a key strategy to address the rise of obesity.

“Unfortunately, while the current version of the Dietary Guidelines mentions portion size – it appears to be mostly an afterthought among the various strategies to improve diets and fight obesity,” said NCL Executive Director Sally Greenberg. “Portion balance is not mentioned in the guidelines’ executive summary; this is despite the fact that larger portion sizes have greatly contributed to the problem of overweight and obesity.”

Nationally, 39.6 percent of adults and 18.5 percent of children were considered obese in 2015-2016, the most recent period for which NHANES data were available. These figures represent the highest percentages ever documented and obesity rates are projected to affect half of all adults, or 115 million adults, by the year 2030. There are also substantial economic losses associated with obesity. The estimated annual medical cost of obesity in the United States was $147 billion in 2008 U.S. dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight. 

“One promising, and we think underutilized, strategy for tackling the obesity epidemic is helping consumers understand and implement appropriate portion control,” said Greenberg. “This simple step to improving public health should not be marginalized in the forthcoming edition of the Guidelines; rather it should be one of the key points stressed by the Dietary Guidelines Advisory Committee and form a cornerstone of the Dietary Guidelines.”

NCL’s full testimony is available here (PDF).

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Consumer groups, food industry jointly call on USDA/HHS to emphasize portion control in next Dietary Guidelines – National Consumers League

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February 6, 2019

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC–Three national consumer advocacy organizations and six leading food industry trade associations joined together to call on the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) to emphasize portion control in the development of the official 2020-2015 U.S. Dietary Guidelines for Americans.

“One promising, and we think underutilized, strategy for tackling the obesity epidemic is helping consumers understand and implement appropriate portion control,” wrote the National Consumers League, the Consumer Federation of America, and Consumer Action. The consumer groups’ letter to USDA and HHS was cosigned by The Grocery Manufacturers of America, the Sustainable Food Policy Alliance (SFPA), the American Beverage Association, the Sugar Association, the National Confectioners Association, and the American Frozen Food Institute.

A copy of the letter can be accessed here.

The consumer groups and trade associations reminded the government that, “The current version of the Dietary Guidelines merely discusses portion size as an afterthought in strategies to improve diets and fight obesity, with the concept not even mentioned in the guidelines’ executive summary.”

Despite an array of consumer education efforts, including mandatory nutrition labeling on food packages and, more recently, on restaurant menus, obesity is still a dire problem. More than two out of three Americans remain overweight or obese, despite such efforts.

The consumer and industry groups noted that, “Larger portion sizes clearly contribute to increases in the rates of overweight and obesity . . . [we] therefore urge the Dietary Guidelines Advisory Committee, once they are appointed and convened, to focus on portion control as a key strategy to address the rise of obesity and related dietary diseases.”

The National Confectioners Association has launched the Always A Treat Initiative. A central aspect of this voluntary industry effort is providing consumers with more choices in smaller portion sized packages. The founding members of the SFPA have taken similar steps.

The Grocery Manufacturers Association has long supported the need for portion recommendations when developing achievable and practical dietary guidance.

The American Beverage Association has committed to offering a wider variety of smaller portion sizes. Members of the American Frozen Food Institute offer a large variety of portion-controlled meal options, and the Sugar Association has publicized that sugar is best enjoyed in moderation.

The consumer advocacy groups and trade associations concluded, “These programs represent cost-effective measures to combatting obesity, but this is only a start. . . . [We] look forward to participating in the deliberations that will lead to the new Dietary Guidelines.”

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Dietary Guidelines 2020: Back to the future for portion sizes – National Consumers League

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Sally GreenbergWith 47 percent of the U.S. population projected to be obese by 2030 – and more than 2.1 billion people expected to weigh in as overweight or obese – it’s no surprise that governments worldwide have waged war on a health crisis which not only causes 5 percent of all deaths every year, but also has a $2.0 trillion economic impact annually. So what new measures can be taken that haven’t already been tried?

Is the solution based in advanced technology or medicine? Or do we need to take a step back and take a look at the bigger picture, and tackle a complex problem with simpler solutions by going back to basics? Research seems to indicate that portion control is one of the most promising strategies.

Advances in technology and entertainment over the past 40 years mean we are moving less. At the same time, our meals and snacks have been supersized. In its latest revision of the nutrition facts panel, the Food and Drug Administration (FDA) has increased some of the standard serving sizes for various food and beverage products to better reflect the total calories people are actually consuming. This could, however, send the wrong message about proper portions of food. And while there are some great nutrition tools and fact sheets available (see for example the National Institute of Health’s page on Portion Distortion), this puts responsibility on the individual to make the right choices. There are also initiatives about portion control from the American Heart Association and the American Cancer Society.

The 2015 Dietary Guidelines for Americans discussed adapting portion sizes to help individuals make choices that align with the Dietary Guidelines´ other recommendations. But this was more of a passing comment without further guidance, and simply not actionable by consumers, health and wellness professionals, or even policy makers.

If real change is going to happen, it not only has to start at an individual level but also via policy based intervention and through corporate action. And there’s compelling evidence to show that portion size reduction, as a collective movement, could be the single most effective solution to an expanding problem.

The food industry’s own research – from the International Food Information Council’s 2017 Health and Wellness Survey – highlights this unmet opportunity, showing that consumers want to consume smaller portions as one of the steps to be healthier, however they are not acting on it, and are instead prioritizing value.

An interesting comprehensive analysis conducted by the McKinsey Global Institute (MGI) is worthy of consideration. The paper found that while education and personal responsibility are critical elements of any program to reduce obesity, they are not the only solutions. Interventions that rely less on conscious choices by individuals and more on changes to the environment and societal norms are what’s needed—an example of this includes reducing portion sizes of packaged foods and fast food.

According to MGI’s research, portion control, as opposed to other obesity intervention methods such as product reformulations, labeling, weight-management programs, surgery, etc., is the single highest-impact intervention for reducing obesity; and the most cost-effective strategy.

Has it been tried? Not really—there was a previous attempt that was never implemented when in 2012, NYC Mayor Bloomberg tried to regulate portions by proposing the “Sugary Drinks Portion Cap Rule” prohibiting certain places from selling sugar-sweetened beverages that exceeded 16-fluid ounces. While the intention of the regulation was not to ban sugar-sweetened beverages, but to assist consumers with portion control, industry succeeded in defeating this initiative – apparently the rule exceeded NYC Board of Health’s regulatory authority.

Since 2012, and despite the supportive research of reducing portion sizes, little has been done to execute an effective policy that would seek to ‘re-size’ all of our packaged foods and beverages to take them back to healthier portion sizes. With the 2020-2025 Dietary Guidelines around the corner, there is no better time than now for policy makers to make a difference. Consumers need and deserve a clear, authoritative voice to provide impactful and easy to implement guidance on portion sizes and portion control for all foods and beverages.

Obesity doesn’t discriminate, but should preventive care be more personalized? – National Consumers League

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obesity.jpgBy Ali Schklair, Linda Golodner Food Safety & Nutrition Fellow 

It isn’t news that obesity is an urgent problem in our country. According to a recent study by the CDC, over one third of US adults are obese. Education and health professionals have presented numerous strategies to combat this growing epidemic. Still, in order to enact real change, there needs to be a greater focus on how overweight and obesity affects specific populations.

Growing up with a brother with disabilities, I was exposed to the many challenges my family faced trying to help him develop healthy habits. Nutrition and weight were always difficult issues to manage. As a kid, my brother was very skinny. He was taking a medication that sped up his metabolism and suppressed his appetite. My parents would beg him to eat anything, even if the food was mostly fat and sugar. But as he got older, changed medications, and moved out of the house, he began to gain weight. Traditional weight loss methods have not worked for him. My brother faces a unique set of challenges, but he certainly isn’t alone. 

Obesity rates for adults with disabilities are 58 percent higher than they are for adults without disabilities. Additionally, obesity rates for children with disabilities are 38 percent higher than they are for children without disabilities. These numbers put adults and children with disabilities at a much higher risk of developing weight-related diseases such as heart disease, stroke, type 2 diabetes, high blood pressure, and certain types of cancers.

So why are these rates so high? As is the case with my brother, many people with disabilities are prescribed medications that cause sluggishness or weight gain. Also, any physical disability affecting motor or balance issues, sight, or stamina can make getting enough exercise challenging. Many people with disabilities are sensitive to the taste, color, texture, and smell of certain foods, which can lead to limited food repertoires.

Along with physical or medical challenges, there are lifestyle differences that make weight loss for adults with disabilities especially difficult.  Adults with disabilities often rely on support staff, family members, job coaches, and nurses to help them through their day. Many adults with disabilities also have little control over their finances. This means food is often chosen and cooked for them, usually the quickest and easiest options.

The disability population faces a range of obstacles when it comes to addressing the obesity epidemic. But it is not just people with disabilities that face unique challenges. In its polling, the CDC has outlined how socioeconomic status, sex, and ethnicity can all contribute to the prevalence of obesity. Once we are better able to understand the barriers to eating healthy and getting adequate physical exercise, we can tailor strategies to address the unique needs of differing populations.