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Popular diets work about as well as more costly and invasive interventions for obesity, such as bariatric surgery, according to participants at ECRI's 12th Annual Conference on Using Evidence in Practice and in Public and Private Policymaking, which focused on preventing and treating obesity. The conference was held in late October in Plymouth Meeting, Pa.
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ECRI, formerly the Emergency Care Research Institute, is a private, nonprofit health device agency in suburban Philadelphia.
Clinicians and policymakers spent 3 days presenting evidence on the efficacy and cost-efficiency of interventions for obese patients. Surgical procedures, drug therapies, and technologies, including the gastric pacer (Gastric Pacing, see page 18), were presented as viable treatment options for morbidly obese patients.
A comparison of consumer-targeted weight-loss programs and surgical and pharmacological interventions revealed that less-expensive lifestyle programs, such as Weight Watchers, were on par with costlier and more invasive therapies. According to presenters at the conference, these lifestyle programs produced similar results, including the reduction of obesity comorbidities.
Among the most effective and economical interventions for obesity are behavioral therapies and lifestyle changes that combine a sensible diet and exercise program.
A reduction in weight of 5–10% can decrease the risk of comorbidities, including hypertension and diabetes, and can be achieved with physician interventions of moderate intensity.
SURGICAL APPROACHES
Bariatric surgery remains a high-risk option for some obese people.
Candidates should meet eligibility standards, which include a body mass index
(BMI) 
35 with comorbidities or a BMI 40 with or without
comorbidities.
For the most part, health plan coverage for bariatric surgery is limited to cases with comorbidities. Few states mandate coverage for bariatric surgery, and access to the procedure is limited in the private-pay market because it can amount to about $35,000 in hospital costs.
Bariatric surgeon Noel Williams, MD, of the University of Pennsylvania Medical Center explains that the procedure typically results in 50% weight loss and up to 95% reduction in type 2 diabetes among the 25% to 35% of patients who have the disease. With obesity rates increasing and the development of safer laparoscopic procedures, it's expected that about 150,000 surgeries will be performed in 2005, up from 120,000 in 2004.
POLICY REVIEW
Despite the effectiveness of surgery and diets, long-term strategies are dominated by prevention and screening programs. Health care policies in both the public and private sectors are being oriented more toward these goals.
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The Medicare Modernization Act of 2003 provides the opportunity for prevention, screening, and new drug coverage under the category of preventive care. It also expands coverage for treatment of obesity-related illness.
"In the past, obesity treatment coverage was limited," says Mark McClellan, MD, administrator of the Centers for Medicare and Medicaid Services (CMS). "In the revised policy, language that prohibited obesity from being considered an illness has been removed."
The increased latitude does not mean that obesity itself has been classified as a disease. However, if deemed necessary, certain preventions and treatments connected to obesity without comorbidities may be covered.
Outside the federal government, initiatives are being studied and have been piloted to foster conditions for weight loss and maintenance, and to increase prevention efforts. According to William Caplan, MD, director of clinical development at Kaiser Permanente's Care Management Institute, successful workplace strategies include allowing employees time for daily exercise, tobacco-free work sites, and the sponsorship of preventive screening.
A SENSE OF URGENCY
Much of the statistical evidence discussed at the conference concentrated on prevention and screening, particularly among children.
"Half of adults with BMI of 40 or more had obesity in childhood," says William Dietz, MD, of the Centers for Disease Control and Prevention. Of the 15% of children aged 6–12 in the U.S. who are obese, approximately 80% will be obese adults.
The pediatric population is a primary target for intervention, given the
grim statistics attributed to childhood obesity. Programs such as revitalized
physical education, school lunch menu evaluations, and school-based
interventions are part of the goal to combat obesity among children.
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