More doctors specializing in weight management

HAMPTON, New Hampshire (AP) -- When Milton Martin Jr. decided he was past
due to lose 30 pounds, the former body builder and college football player
couldn't bring himself to join a diet center.

"I don't function well in group therapy," he said, adding that he'd tried
Weight Watchers and hated the meetings.

The 64-year-old accountant wanted more science and less socializing. He
also wanted a plan that addressed all of his concerns -- including his
escalating cholesterol -- not just his belly.

Now he sees Dr. Jennifer Warren, one of a small but growing number of
physicians nationally who are specializing in weight management after their
family practices were overwhelmed by patients with weight-related health
problems.

"Primary care is preventive medicine. This really is the ultimate
preventive medicine," said Warren, who left her general practice in
February to open Physicians Healthy Weight Center, a Hampton, New
Hampshire, obesity clinic.

"That's what got me started in this direction," the 39-year-old said in a
recent interview. "So many of the medical problems I was treating in family
care were weight-related."

Three weeks into his treatment, Martin's cholesterol was down and he'd lost
12 pounds, thanks to low-dose appetite suppressants and calorie-cutting.
And he doesn't miss the meetings.

"If I'm going to lose weight, I'm not going to lose it for the group," the
Durham man said. "I'm going to lose it for me."

Redefining roles
With two-thirds of Americans now overweight and at greater risk for heart
disease, diabetes and certain cancers, many in the medical community want
to redefine the role doctors have in helping people slim down.

Doctors say the pressures of general practice -- which can limit time with
patients to mere minutes -- and a lack of specialized training make it
difficult to treat obesity in a primary care environment.

They say treatment involves not only creating individualized diet and
fitness plans, but also assessing serious health concerns and addressing
the underlying emotional and psychological issues that contributed to the
weight gain.

"In eight minutes you can't undo all that stuff," said Peter Vash, a Los
Angeles doctor who has treated obesity for 25 years.

Though often associated with gastric surgery, a procedure that reduces the
size of the stomach, so-called bariatric medicine includes a gamut of
treatments, from special diets to counseling to prescription drugs.

The impetus for change comes mostly from medical schools, according to Dr.
George Blackburn, associate director of Harvard Medical School's nutrition
division.

Medical students and young doctors are demanding to know more about
nutrition and weight management, which previously was absent from most
curricula, he said.

"We always ask physicians whether they see obese patients in the practice.
They just laugh at us and say at least half," said Beth Little, executive
director of the American Society of Bariatric Physicians.

"They used to say there was nothing they could do," she said. "Now they are
just taking it a lot more seriously."

Slow change
Head counts of bariatric physicians are imprecise; the field isn't tracked
by the American Medical Association.

Little's group has 1,104 members, an increase of 165 from two years ago.
The American Board of Bariatric Medicine has 236 certified physicians, and
expects to add another 50 this year. Most years the increase has been
around 30.

There have been spikes before, fueled mostly by popular drugs and
procedures, such as the now banned diet drug fen-phen and more recently a
surge of interest in bariatric surgery. But Little said this time the
interest is more sustained.

Academia has noticed. The theme of Harvard Medical School's annual
conference on obesity in June is "Obesity Medicine: Emergence of a New
Discipline."

Earlier this month, Duke University Medical Center announced it now will
offer fourth-year medical students a course in the causes and treatment of
obesity.

But change is slow. Though medical schools are improving at teaching
nutrition, doctors complain that instruction still is limited mostly to
postgraduate courses.

"When I came out of medical school in 1992, all we were told is tell your
patients don't eat fat," Warren said.

Until recently, the specialty struggled for respect. Vash, executive
medical director at Lindora Medical Clinic in Los Angeles, said his
decision to enter the field more than two decades ago mostly was derided by
fellow doctors.

"Many of my colleagues looked at me and laughed," he said. "Why would you
go into treating obesity? That's like the bottom of the barrel."

It wasn't until obesity was declared an epidemic some 20 years later that
others took the field seriously, he said.

Financial issues
Money also is an issue. Though most insurers offer discounts for fitness
and diet programs and cover nutrition services and even gastric surgery,
coverage for services such as Warren's is spotty, making it hard for
doctors to get into the field.

Warren charges $95 for the first visit, which includes an exam, creating
fitness and diet programs, and monitoring and treating any related health
problems.

Monthly appointments thereafter are $75. Warren points out that her fees
still are probably less than diet programs that require special food
purchases.

Susan Pisano, spokeswoman for America's Health Insurance Plans, a trade
group, said this is an emerging field being studied by the industry. She
noted that in 2002 a quarter of insurance plans included some kind of
disease management plan for obesity.

Bariatrics also can be frustrating and not very glamorous. Treatment can
take months or years, and its success depends as much on the patient's
motivation as the doctor's intervention.

"It may not be as glamorous as a heart transplant or as rewarding as
treating pneumonia and having the patient get better in a week, but it is
very glamorous in the sense that you are giving this person a whole new
orientation on life," Vash said.

He also said the delay in recognizing the importance of bariatrics will
prove troublesome for years to come.

"There are going to be so many patients coming to physicians for the
treatment of their heart disease, and their diabetes, and their lipid
problems and their back and knee pain that it has the potential to
overwhelm our health care system," he said.

Doctors in the field don't consider themselves in competition with
over-the-counter approaches, including popular diet centers such as Weight
Watchers, saying people should use whatever method works for them.

But they say health concerns make them a better choice for many patients.
Doctors also can enhance accountability.

"You're really committing yourself when you're going to a physician,"
Little said. "If you don't show up (at a diet center) nobody's going to
say, 'Oh, where are you?' There's a difference between that and missing a
doctor's appointment."

I read this off the web earlier today. My biggest problem is the
example patient was put on appetite suppression(i'm sure the curretn
one is much safer than phen phen). They also specialize in those
bizarre stomach surgeries. Those new and "better" ways of losing
weight don't strike me as good things.


DiGiTAL_ViNYL (no email)
350/304/Apr-299/200
Atkins since Jan 12, 2004
OWL-50 carbs/day (CCLL=?)

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