Article Date: 7/1/2012

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nutrition

Weighty Matters

In a country obsessed with weight, how can you help your patients?

Kimberly K. Reed, O.D., F.A.A.O.

How many times a week do you hear obesity mentioned? In your local grocery store's checkout line, what percentage of magazine covers address weight? When you type a celebrity's name plus “weight” in a search engine, see what happens.

We are a nation obsessed with weight — our weight, our favorite celebrity's weight, even the weight of a perfect stranger, who undergoes a magical transformation on a national television show.

Strange indeed, then, that so few of us discuss this obsession with our patients.

Statistically speaking

Roughly a third of U.S. adults are overweight (their Body Mass Index, or BMI, is 25 or higher); and another third are considered obese (their BMI is 30 or higher), according to Centers for Disease Control and Prevention statistics (www.cdc.gov). (See “What is BMI,” right.) So, two out of three of our adult patients must reduce their body mass for wellness.

Moreover, a 2010 paper revealed that the quality-adjusted life years lost from obesity is at least equal to, if not greater than, those years lost from smoking.1 Medical spending from obesity now exceeds that spent on smoking-related health problems. (See “The High Cost of Obesity,” page 77.)

Yet a survey my colleagues and I recently presented to other O.D.s revealed that, in general, O.D.s don't hesitate discussing smoking cessation with their patients, while discussing weight loss seems far more challenging. Despite obesity's role in diabetes and diabetic retinopathy, hypertension and hypertensive retinopathy, several types of cancer and a myriad of psycho-social problems, it's often thought as too personal a discussion to broach during an otherwise uneventful eye exam. This absolutely needs to change. But how?

What is BMI?
Body Mass Index (BMI) is a number calculated from a person's weight and height. According the Centers for Disease Control and Prevention, BMI is a “fairly reliable” indicator of body fatness for most people. Calculate BMI by dividing weight in pounds (lbs) by height (inches) squared and multiplying by a conversion factor of 703.

How to get started

Provide patient education materials about obesity and food choices in your waiting and individual exam rooms. These materials are an easy, low-cost avenue to introduce obesity to your patients in a non-threatening manner. To obtain these materials, visit www.choosemyplate.gov and http://mypyramid.gov.

Something else likely to facilitate this discussion is the incorporation of Meaningful Use data with Electronic Health Records. BMI data is being gathered, and as more O.D.s adopt the new MU requirements, BMI will become a normal, everyday collected data point.

Having the data, an opening point for an obesity conversation might start: “One of the things we measure is your BMI, which is a ratio of your height and weight. Your BMI is above the healthy range.” This statement eliminates the patient's embarrassment, and having a clinical measurement of body weight eliminates the need to “eyeball” a patient's size, and make a judgment, all for the cost of a reasonably good scale. Most importantly, if you broach the subject, you must follow it with a discussion of a meaningful and realistic remedy for the problem.

The basics

Many optometrists are already quite knowledgeable about weight and nutrition. If you're not among them, it's essential you, as a primary healthcare provider, possess a basic understanding of obesity and its many causes. (Websites, such as www.webmd.com, provide this basic information.)

It is an unfortunate misconception that overweight or obese people just lack the willpower to stop eating. The causative factors are far more complex than that, and knowledge in this area is still emerging. These factors include genetic features, neurobiological pathways, psychological disorders, hormonal imbalances, nutrient deficiencies and imbalances and quite possibly several other contributing factors. Once patients are assured you understand their problem may go beyond a junk-food habit, they will undoubtedly be more receptive to discussing potential solutions.

On the other hand, more than a few patients are likely to reply to you with some version of, “Doc, I've tried everything, and I still can't lose weight. I just give up.” Arm yourself with non-emotional responses to this inevitable pushback, such as, “If you're having trouble, here are some sources that can help.” Then give the patient the aforementioned web sites, or offer to refer him to a qualified nutritionist or registered dietician. Prepare yourself for this conversation by finding out what options, with respect to nutrition and lifestyle management, might be available for your patients — much of which may depend upon insurance status. A quick trip to the websites for the predominant insurance providers in your area might yield useful information that can be passed to your patient.

The High Cost of Obesity
It extends far beyond direct healthcare costs.
In 2008, the estimated medical care cost for obesity was roughly $147 billion, says the Centers for Disease Control and Prevention, (www.cdc.gov). A 2011 analysis by the Society of Actuaries (www.soa.org) puts the U.S. cost of obesity at closer to $270 billion, including medical costs, loss of worker productivity, higher rates of death and disability.
While the numbers for our entire country are staggering, a 2010 study estimated an individual's cost of obesity. The study, “A Heavy Burden: the individual costs of being overweight and obese in the United States” (Avi Dor, Ph.D., et al, George Washington University) found that being an obese woman in the United States costs $4,879, while an obese man spends an extra $2,646 per year, and that doesn't take into account obesity's reduced life expectancy, which would make the per-year price tag even higher.
What goes into those figures besides the direct cost of medical care for obesity-related conditions? Lost wages, for one — and not just lost income from being absent from work for a diabetes checkup. Scores of studies show obese and overweight people make far less than their slender colleagues, and this trend is more significant for women than men. Nearly every aspect of a person's life is affected by their weight, right down to the amount of gasoline they use for their cars.
About two-thirds of us are overweight or obese currently. If we continue at our current “growth” rate, roughly half the country will be obese by the year 2030. By that time, or even sooner, roughly 44 million people in the United States will be full-blown diabetics, with another substantial number qualifying as prediabetic. The costs to care for a diabetic patient with complications are roughly four times that of a non-diabetic, on an annual basis. Through the next 25 years, the cost of treating just diabetes is expected to triple to $336 billion per year, says “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead,” from United Health. Clearly, just knowing these alarming facts and figures isn't enough to conquer the problem. It will take game-changing measures if we are to slow this unhealthy and financially crippling trend.

For non-insured or underinsured patients, determine whether nutritionists practice in your area, and find out pricing ahead of time. A specific recommendation with a nutritionist's contact information and pricing is more meaningful than the advice to “Go see somebody about that.” Also, keep in mind many pharmacies now offer nutrition counseling free of charge on a limited basis. This fact alone might be enough to get someone started in a healthier direction.

Properly addressing the overweight and obesity epidemic in our country requires a comprehensive, unwavering, focused effort from every possible corner. You, the optometrist, should step up as an essential part of that process. OM

1. Jia H, Lubetkin EI. Trends in quality-adjusted life-years lost contributed by smoking and obesity. Am J Prev Med. 2011. Feb;38(2):138-44.

DR. REED IS AN ASSOCIATE PROFESSOR AT THE NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OPTOMETRY IN FORT LAUDERDALE, FLA. A MEMBER OF THE BOARD OF THE OCULAR NUTRITION SOCIETY AND AUTHOR OF NUMEROUS ARTICLES ON OCULAR NUTRITION, DISEASE AND PHARMACOLOGY, SHE IS ALSO A FREQUENT CONTINUING EDUCATION LECTURER. TO COMMENT ON THIS COLUMN, E-MAIL DR. REED AT KIM REED@NOVA.EDU.


Optometric Management, Volume: 47 , Issue: July 2012, page(s): 76 77