Dear Dr. Benjamin

I had the privilege to hear and meet our Surgeon General, Dr. Regina Benjamin, at UAB yesterday as we kicked off National Nutrition Month with a great event sponsored by the Department of Nutrition Sciences. In one of the introductions describing the wonderful person that she is, Dr. Benjamin was described as the health care Santa Claus for the nation. She has been preaching a message of joyous health and working hard to bestow the gift of healthiness for all. As the nation's doctor, she has worked to deliver a message that our health care system should be focusing on health promotion and prevention of disease just as much as we focus on developing the best medical technology in the world for treating disease. Since we were there to focus on nutrition, a lot of her remarks dealt with obesity. I figured that I might follow up with a Christmas list of things I'd hope to see as we all try to fight the obesity issues we face.
My list for healthcare Santa Claus:

1. Prescriptions for healthy eating- as a primary care trained internist, I know and appreciate the benefits of modern medicine. Prescriptions for medications to control acute and chronic diseases are wonderful to have available; the insurance coverage for these medications is even better (when available). I would like to see us use prescriptions for healthy foods in a similar way. Let those of us with the appropriate training (physician nutrition specialists, dietitians, nurses, etc) prescribe healthy food options for those at risk for or those who have preventable diseases. The prescriptions would provide a voucher or some discount on the prescribed foods (primarily low energy dense fruits and vegetables, lean protein, nuts, beans, and healthy fats). By paying for these foods, we may save money on medications that don't prevent the conditions or expensive procedures that are needed because the conditions are out of control. We have an exercise is medicine movement that has been active for some time now…I see food as medicine as the next step.
2. Provide insurance coverage for obesity treatment by obesity specialists- I know that Medicare has announced that reimbursement for obesity counseling will be provided to primary care practitioners in the near future. Most of us still doubt that this will lead to effective treatment because the primary care practitioner has little training and fewer resources to deliver the type of therapy that has been shown to be most effective. With all of the great resources I have at my disposal and the primary focus of my career being obesity treatment and weight management, I still find it challenging to do the things we do. I would like to be able to prescribe the most effective treatment for my patients, regardless of considerations about the patient's ability to pay, but I can't because all of the effective medical therapies we have available are not covered by insurance. So, those who often need it most are forced into an alternative that may be less than ideal, even when they have good insurance. I'm not suggesting that primary care practitioners shouldn't be involved…I believe they play a critical role in raising awareness, helping patients make the connection between body weight and health issues, and providing referrals to credible treatment options. However, we need to develop medical and behavioral specialists (physicians, psychologists, dietitians, exercise therapists, nurse practitioners, PAs, etc) who can treat complicated obesity just in the same way as the surgical field has the bariatric surgical specialist.
3. Get rid of the junk- My last wish is for Santa Claus to get rid of the snake oils and phony treatments being peddled as "cures" for obesity. If we could limit the amount of time and effort being put into these supposed treatments that have no scientific evidence as being effective, our patients would save a lot of time and money. This time could otherwise be focused on developing the skills and knowledge necessary for people to take better care of themselves and develop healthy lifestyle habits. We've finally gotten the FDA to declare HCG treatments for obesity as fraudulent. Hopefully, this trend will continue, and we can elevate the practice of obesity treatment to a higher standard. I think my wish list item #2 is critical to seeing the evolution of treatment and disappearance of the snake oils.