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Kenneth E. Thorpe, Curtis S. Florence, David H. Howard, and Peter Joski, Trends: The Impact Of Obesity On Rising Medical Spending, Health Affairs Web Exclusive, October 20, 2004 [Abstract] [PDF] [HTML Version] [Reprints & Permissions]

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Some Concerns About Obesity Stigmatization

Bradford Kirkman-Liff   ( 20 October 2004 )

Insurance Companies Falling Down on the Job

Bonnie P. Travis   ( 8 November 2004 )

Some Concerns About Obesity Stigmatization 20 October 2004
Bradford Kirkman-Liff, Professor of Health Policy and Biotechnology W. P. Carey School of Business, Arizona State University Send comment to journal: Re: Some Concerns About Obesity Stigmatization bradford.kirkman.liff{at}asu.edu Bradford Kirkman-Liff	The paper by Thorpe and colleagues is a very clear presentation of the issues. I very much agree with the intent of the last statement: "This will require a focus on developing effective interventions to promote weight loss among obese people." However, the problem is not the promoting of weight loss, but rather sustaining the achieved weight reduction over time. The problem is that there is a high recidivism rate with current obesity treatments. Individuals often can lose some weight, but then over a period of time regain the weight and not simply return to their original level of weight but end up at an increased weight. In my view, the 1991 NIH Consensus Conference Statement on Gastrointestinal Surgery for Severe Obesity [1] should be revisited, as it has had the effect of reducing insurance coverage for morbid obesity. There has been significant growth in the literature on this issue. The research agenda outlined by that should be more vigorously pursued. I am somewhat concerned that we are in the early stages of a public health stigmatization of obese similar to the stigmatization of smokers. I have heard some public health leaders argue that the success in tobacco control efforts is in part attributable to the stigma that has been created around smoking and that a similar stigma around obesity should be encouraged. This disturbs me. Stigma and discrimination in obesity have been found to be present even in the health care providers who treat obese patients.[2] One barrier to effective obesity treatment is the self- stigmatization that obese patient feel, which can start in childhood.[3] Reduction in obesity will only be possible if this illness is destigmatized and providers treat morbidly obese patients with the respect that any other patient receives. References: 1. Gastrointestinal Surgery for Severe Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20. http://consensus.nih.gov/cons/084/084_statement.htm 2004-10-20. 2. Kelly Brownell, Rebecca Puhl “Stigma and Discrimination in Weight Management and Obesity” The Permanente Journal 2003 Summer: 7(3): 21-23. 3. Richard S. Strauss “Childhood Obesity and Self-Esteem” 000;105;15- Pediatrics 2000 January 105(1): e15+ http://pediatrics.aappublications.org/cgi/content/full/105/1/e15 2004-10-20
Insurance Companies Falling Down on the Job 8 November 2004
Bonnie P. Travis, Asst. Manager Blue Cross Blue Shield of Kansas City Send comment to journal: Re: Insurance Companies Falling Down on the Job paulettetravis15{at}yahoo.com Bonnie P. Travis	I think it is a shame that insurance companies can deny you medical treatment, even if it is medically needed. I suffer from morbid obesity. I have been fighting with my insurance company for over a year now, for approval of gastric bypass surgery. They say it's not covered under my policy. They can see where I medically need the procedure, but they're not going to pay. If I were a drug addict, an alcholic, or mentally unstable, they would cover treatment for that. Obesity is a disease. I am not fat because I want to be. I think our government or someone should make insurers responsible. Please, if anyone can help, we need you.