17 October 2017

Focus sharpens on obesity care plans

Clinical Obesity

Two major Australian medical societies have officially defined obesity as a “disease”, and experts are urging GPs to utilise care plans to help patients manage the condition and access treatment.

Obesity was originally prohibited from funding under GP Management Plans, but the eligibility criteria was changed, largely unnoticed, years ago.

“Historically, when the Department of Health described which health conditions were eligible for chronic disease plans, they listed various eligible diseases,” Dr Georgia Rigas, chair of the RACGP’s obesity management network, said.

“Way back then, obesity was specifically named as an excluded health condition.”

Since then, a list of inclusions and exclusions have been dropped, meaning patients with a BMI of 30 or more and no “apparent comorbidities or complications from their excess weight” were eligible, considering the chronic and progressive nature of the disease, Dr Rigas said.

For years, debate has raged over whether obesity should be considered a disease or simply a chronic condition, with proponents of the disease label arguing it would give the problem gravitas in the community and among policymakers.

Now, joining the Australian and New Zealand Obesity Society which issued a media release earlier in the month, the RACGP has also officially labelled obesity a disease.

Dr Rigas hoped this would have a “ripple effect”, prompting other medical groups such as the AMA to follow suit.

College President Dr Bastian Seidel made the call, urging GPs to act early, noting that obese and overweight children had a quality of life as poor as those with cancer.

In Australia, two in three adults and one in four school children are overweight or obese.

If nothing changes, 2.7 billion adults globally will be overweight or obese by the end of the decade.

“Sadly, there is a real risk that these children might not outlive their parents,” Dr Seidel said.

“There is a serious sense of urgency, and the time to act is now.”

For Dr Rigas, recognising obesity as a disease should help change its perception in society, improving health outcomes for people who “suffer significant degrees of stigma, discrimination and weight bias and as a result may be reluctant to access healthcare”.

“Very few understand that the causes of obesity are multiple and complex including epigenetics, and alteration in the gut microbiome,” she said.

“While the heritability of obesity has been shown in twin studies and clinical practice, there are only a small percentage of patients who have a purely genetic cause.”

Dr Rigas has been a long-time critic of the inequitable treatment available to patients with obesity, highlighting the vanishingly small capability of hospitals in the public sector to offer bariatric surgery, and the dearth of any obesity medication covered by the PBS.

Funding did not come close to that available for other serious medical conditions that represented a significant public health concern, she said.

Along with the change in label, the College is also suggesting a shift in health messaging from “lose weight” to “gain health” in recognition that obesity is about more than body weight.  In addition, the College is promoting weight screening to become routine in general practice.

“Start screening ALL patients in [general] practice, young and old,” Dr Rigas said. “For children, their parameters need to be plotted on a BMI-for-age chart; for adults BMI and waist circumference, taking into account their ethnicity (as different cut- offs for different ethnic groups) and physical activity levels (if they are muscular or not) are important.”

As a baseline of care, the RACGP says waist circumference and BMI need to be taken every two years in the general population and annually for those with diabetes, cardiovascular disease, stroke, gout or liver disease, or if they are from high risk groups, such as Aboriginal and Torres Strait Islanders or Pacific Islanders.

These measurements are recommended twice a year for patients who are already overweight or obese.