Those of us who supported some kind of government health care bill for the 38 million uninsured were duped.

Our hope was that a government program could help some who lack health insurance (or the underinsured who would go bankrupt if they had a health emergency). These folks would now have a safety net for times of trouble.

Instead, Obamacare is morphing into a behemoth that will not only pay for the birth control pills of Spanish riviera vacationing coeds but will  pay a doctor to tell Rosie O’Donnell or Oprah to go on a diet–and then pay for their treatment.

From the  LATIMES:

 Obese adults should get counseling, federal task force says

Under the healthcare law, insurance companies would be required to cover the panel’s recommended weight-loss treatments.

Yes, not only will we docs have to “screen” you for a diet (and document in triplicate on our new expensive electronic medical record program that the government says we have to use) but we will have to refer you for free “weight loss treatments”.

No hard information if this means it that Uncle Sam pay for you to join weight watchers or pay for your diet pills, or pay for weight loss surgery. (The devil is in the details, but I’d keep an eye on which company’s stock goes up in the next few days: the commercial weigh loss programs or the drug companies).

But from experience, I suspect it could easily mean every slightly overweight middle class woman will now come into our offices and declare she needs her diet pills paid for, while the poor will be given appointments to be lectured by experts on what to eat (and many will probably just skip these appointments).

I am not dismissing obesity as an illness, or the problem of metabolic syndrome/obesity and diabetes. We did screen and counsel all the time in the IHS, (federally funded clinics for Native Americans). The tribal gyms did help though: one elderly lady told me she was happy she could now walk every day without the risk of being attacked by a black bear.

So why be sarcastic about the program?

One, it is for everyone. It does not target high risk populations but is for anyone. So the  the healthy middle class folks who don’t need it will be the ones to benefit the most.

And then there is this dirty little secret about obesity: when you diet, the body views it as starvation, so it adjusts your metabolism to put on weight to keep you alive during the next famine.

From the NYTIMES:

While researchers have known for decades that the body undergoes various
metabolic and hormonal changes while it’s losing weight, the Australian  team detected something new. A full year after significant weight loss,  these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost….

A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels.

It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.

So in the real world, such programs have limited success.

Let’s use this CDC as an example:

A pilot program considered a model by the task force is now being launched in 21 cities by the federal Centers for Disease Control and Prevention.

It is based on a clinical trial, the Diabetes Prevention Program, that encouraged modest improvements in food choices and at least 150 minutes
of weekly exercise for participants, who were at high risk for
developing diabetes.

The subjects, who typically met weekly for six months and monthly for
the second half of the year, lost between 5% and 7% of their body weight
and reduced their diabetes risk by 58%.

Sounds great, doesn’t it?

But once you look at the details of such programs, the benefits seem a bit less dramatic.
Take this “win to lose” program a community program 

Methods

Participants in the 2005 Lose to Win weight loss challenge visited the Herald-Sun Web site and anonymously entered a nickname and identification number and reported their weight each week. Participants had access to weekly articles on diet and physical activity and 4 free educational seminars.

Consequences

Of the 154 participants who self-reported weight at baseline and during the last week of the challenge, the mean weight lost was 5.9 lb.

See: it works!
Then you read the small print: 705 signed up, but they eliminated most of them from the final results:

A total of 705 people signed up for Lose to Win.

We  excluded from analyses 260 participants who did not have a baseline and at least 1 additional weight recorded during the challenge.

We excluded another 291 who did not record weight in the final week of the challenge or who had duplicate identification numbers.

Because participants were inconsistent about submitting weight throughout the challenge, we analyzed only those participants who had reported weights for both week 1 and week 15 (the final week), for a sample of 154 participants (or 21.8% of the original 705).

The “success” was a sham, because even in this group of “volunteers” only one in five managed to complete the program.

Another problem: there was no “control” group to see if a similar percentage of folks who didn’t bother to join would have lost a similar amount of weight on their own.

And of course, we are not told how much this program cost.

Why not just give grants to grass roots organizations who work in high risk areas to run such programs?

In a time when money is tight, why the push to fund expensive elective programs that would be mainly used by low risk populations for cosmetic weight loss?
Follow the money?

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Nancy Reyes is a retired physician living in the Philippines

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