When the American Medical Association classified obesity as a disease earlier this year, the general response was strong. Finally, the nation's doctors could attack the problem with much-needed medical intervention. They could recommend and enforce weight-loss regimens, rather than suggest them.
Not so fast.
A recent TeleVox survey highlights the problem succinctly. While 78 percent of Americans surveyed said they could benefit from losing weight right now, and 90 percent of Americans – and 97 percent of healthcare providers – agree that diet and exercise can be used effectively against obesity, only 37 percent have reported successfully losing any weight.
The stigma surrounding obesity hasn't changed – weight gain is a touchy subject regardless of whether it's classified as a disease or a lifestyle. What the AMA did accomplish, though, was to change the nature of the discussion, bringing the doctor and the patient together on a medical issue. In doing so, it also pushed mHealth tools and services into that conversation.
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The study "shows that there is a problem in communication," said Allison Hart, director of communications for TeleVox Software, which released "The Obesity Epidemic: Unhealthy Habits Result in a Growing Problem" in September. She pointed to survey findings that indicate 40 percent have talked to a doctor about their weight, while 27 percent of doctors have said their patients have brought the matter up.
mHealth "is something that obesity really cries out for," said Anne Meneghetti, executive director of medical information for Epocrates. The AMA ruling, she said, "really helps shine a light" on obesity, and pushes care coordination tools to the forefront.
But a doctor can't convince an obese patient to lose weight unless that patient wants to lose weight. In a scenario playing out across the entire chronic disease spectrum, mHealth advocates are finding that they have to do a better job engaging the patient and finding a way to induce behavior change.
"If you start weighing yourself, you actually lose weight," said Jacob Arnold, an executive with Fitbit, who argues that mHealth devices can be used to reduce the need for clinical interventions and thus make consumers more comfortable about losing weight.
David Kirchhoff disagrees. Speaking at the recent Partners HealthCare Connected Health Symposium in Boston, the former CEO of Weight Watchers International, said the AMA decision is a "useful first step," but "the only thing that matters – period – is sustained engagement."
"The reasons why people overeat are incredible complex – this is not rational man at his best," Kirchhoff said. "Willpower is an overrated virtue."
Epocrates' Meneghetti sees obesity as a "lifestyle management issue" that "requires support on a regular basis," particularly at those times between clinical visits. "Obesity is not like other conditions," she added. "It's not convenient. It's multi-modal."
Pointing back to the TeleVox study, Hart said mHealth could bridge that gap because it enables consumers to engage with providers on their own terms. They might want to lose weight, but "there's the embarrassment that comes with it" that hinders them in talking face-to-face with a doctor.
"And it is a two-way street," she added. "Providers have to understand their role in this."
"Patients need to see visual progress," said Meneghetti, and mHealth "gives (providers) those tools to mark that progress" and compel behavior change.
Kirchhoff urged providers to start immediately. "This has to matter," he said, "and in a capitated world, this does matter."
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