As obesity epidemic rages, CMs have an opportunity to step in
As obesity epidemic rages, CMs have an opportunity to step in
Modifications in diet, exercise, behavior are essential for success
You read it in the newspaper or hear about it on the news almost every day: The country's obesity epidemic is out of control. And with Americans' ever-growing girth comes an epidemic of health problems, ranging from hypertension and diabetes to osteoarthritis and heart disease.
It is estimated that 93 million Americans are obese and the figure is expected to rise to 120 million in the next five years, says James Zervios, spokesman for the Obesity Action Coalition, a Tampa, FL-based organization formed to educate the public about obesity.
About 65% of Americans are overweight or obese, according to the American Obesity Association. Medical costs attributed to obesity and being overweight accounted for 9.1% of total medical costs, or $78.5 billion, in 1998, according to the Centers for Disease Control and Prevention.
According to the Agency for Healthcare Research and Quality, hospital stays for obese patients increased 112% from 1996 to 2004. Patients admitted for weight loss surgery had 126,000 hospital stays at an average cost of $11,700 per stay. Those admitted for other diseases had 1.6 million hospital stays for conditions such as hardening of the arteries, congestive heart failure, osteoarthritis, depression, diabetes, and chronic obstructive pulmonary disorder. The average cost per stay for those patients was $8,800.
More than 400,000 deaths each year are attributed to obesity, according to the American Obesity Association.
"Obesity affects every body system. As the BMI goes up, not only does the incidence of co-morbidities go up, but the severity increases," says Pamela Davis, RN, CCM, clinical coordinator for bariatric surgery at Baptist Metabolic Surgery Center of Baptist Hospital in Nashville, TN, and a member of the advisory board for the Obesity Action Coalition.
For instance, up to 80% of morbidly obese patients have some degree of depression. There is a higher instance of cardiovascular disease, gall bladder disease, osteoarthritis, diabetes, esophageal cancer, and stroke among the morbidly obese, Davis says. Women are likely to have gynecological abnormalities that affect their menstrual cycle and fertility, she adds.
What constitutes obesity? It's all determined by body mass index (BMI), a formula that is based on height and weight. A BMI of 19 to 24.9 is considered normal. A person with a BMI of 25 to 29 is overweight. A BMI of 30 to 39 is considered obese. People whose BMI hits 40 are considered to be morbidly obese.
BlueCross BlueShield of Tennessee includes obesity management as part of the company's Total Health Management program and takes a proactive approach to weight loss, says Nancy Alsgard, RN, managing director of medical clinical strategy for the Chattanooga-based health plan.
"We have an obligation as a leader in the health care industry to influence peoples behaviors to help combat obesity. We feel a responsibility to educate our members on the evolving concept of the foundational principles of being overweight and obesity so members can make more informed decisions about their health. Our goal is to aid members in avoiding illness burden that may lead to chronic or acute disease or even hospitalization," Alsgard says.
Case managers in the Total Health Management program help members with weight loss as part of the continuum of care of disease management, says Jackie Flowers, RN, CCM, manager of total health management. "Many of our obese members are referred to the Total Health Management program in conjunction with an acute or chronic illness that has obesity as an underlying factor," Flowers says.
For instance, a member may be referred following a diagnosis for hypertension or diabetes or after a stroke or hearth attack.
"We look at the whole picture of the patients health. Dealing with obesity as a single disease is very short-sighted. We view a patient's health as a whole and how it potentially impacts not only their clinical health but also their psychological and financial well-being. It would be detrimental to focus on weight as the end point because obese patients typically have co-morbidities and associated personal matters they must also cope with, "Alsgard says. For that reason, the health plan's Total Health Management program is closely linked with BlueCross and BlueShield of Tennessee's dental division.
"We have found that many obese people have enormous amounts of dental hygiene problems, which can lead to heart disease. We concentrate on facilitating care for the member as a whole, not just delivering care structured around a particular component," Alsgard says.
When the case managers get a referral to manage the care of a member who has obesity as an issue, they provide telephonic case management and support to help the member lose weight. The case managers provide the members with educational materials, refer them to support groups within the community, and work with them to develop diet and exercise goals. "We take it in baby steps, setting small goals that the member can reach. The next time we talk to the member, we repeat the goals and see if they have met them," Flowers says. Managing obesity involves more than just losing weight, Davis adds.
"Morbid obesity is a problem that must be dealt with on many levels. A person's social and emotional issues need to be addressed as well as the physical issues. Too frequently people think of a diet as a temporary means to an end. But once they meet their goal, they go back to their previous way of eating and the weight comes back," she says.
Patients may be eligible for weight loss medication or weight loss surgery depending on their body mass index but they still have to address diet, exercise, and behavior modification, she says. "All three components need to be addressed whether someone is trying to lose three pounds or 300 pounds," she says. In many cases, the medications a patient may take to treat a co-morbid condition may predispose him or her to weight gain, Davis points out.
"Co-morbid conditions and weight gain are interrelated and it's typically a vicious cycle that involves far more than just pushing away from the table to combat it," she says. Following patients across the continuum can help reinforce the lifestyle changes necessary for weight loss, Davis adds. Many need psychological help to deal with the lower self-esteem that being overweight can bring, she says.
You read it in the newspaper or hear about it on the news almost every day: The country's obesity epidemic is out of control. And with Americans' ever-growing girth comes an epidemic of health problems, ranging from hypertension and diabetes to osteoarthritis and heart disease.Subscribe Now for Access
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