April 08, 2014

Treating Obesity- It’s time to put our money where our mouth is!

Dr. Ritu Grewal, MD, Clinical Assistant Professor of Medicine, Division of Pulmonary & Critical Care Medicine at Thomas Jefferson University

The rising epidemic of obesity in the United States and the rest of the developed world is having a tremendous impact on the health and well-being of individuals along with major economic consequences to society at large. It is well established that obesity is associated with hypertension, coronary artery disease, diabetes, obesity hypoventilation syndrome and sleep apnea. Significant reduction in weight, as achieved with bariatric surgery has been shown to reduce the prevalence of these diseases. However, even minor reductions in weight have been shown to alleviate symptoms and reduce morbidity and mortality in select groups of individuals.  It also contributes to overall well-being of individuals, reduces healthcare utilization and costs, which in turn would have a beneficial impact on the economy.

But, like smoking cessation we pay lip service to this problem in our everyday clinical practice. Why? There is not enough time to spend discussing this issue in the limited time allotted for the patient. Patients and physicians (especially if they themselves are obese) are uncomfortable discussing it. Insurance companies are not providing reimbursement, other than for bariatric surgery which patients are reluctant to undergo. Our clinical practice guidelines in Sleep Medicine give weight loss a GUIDELINE rating as opposed to a STANDARD rating. It is recommended as adjunctive therapy in the management of sleep apnea behind the other primary treatments which include PAP therapy, surgery and oral appliances.

In his editorial, “The Need for a greater focus on Obesity and Its Treatment in Sleep Medicine”, David Hudgel, MD makes a very compelling argument for sleep physicians to incorporate weight loss measures as a central component of their practice. I agree. We need to develop a closer working relationship with practitioners treating obesity. We need to start offering it as primary treatment in select patients especially with mild sleep apnea and even moderate sleep apnea with no cardiovascular morbidities. It needs to be a strong adjunctive measure in patients with severe sleep apnea. We need to spend time educating our patients and offer resources to help them achieve this goal.

This truly life threatening problem needs to be taken seriously! At the Jefferson Sleep Center we have begun this important work with our partners in endocrinology, nutrition and bariatric surgery. We are making a strong effort to recommend this tool to our patients. We will be offering it as an alternative treatment in select individuals and as an adjunctive treatment in all obese patients. Hopefully the loss in pounds will be a gain in overall health.

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Jefferson