Christine Ferguson

Obesity Drug Outcome Measures: Results of a Multi-Stakeholder Critical Dialogue

There has been great interest in what role drugs should play in the treatment of obesity. Given the complex and multifactorial nature of obesity, drugs represent a valuable adjunct to traditional obesity treatments. However, obesity drugs present specific regulatory challenges, due to the sheer number of individuals affected, the heterogeneity of how obesity affects individuals differently, and the potential for drugs to be misused, especially by those seeking or profiting from cosmetic weight loss. There is a need to refine the characterization of the individuals most at risk from obesity to better assess the balance of benefits versus risks and determine appropriate candidates for drug therapy. As obesity affects feeling, functioning, and survival, outcome measures that reflect improvement in these domains should be explicitly incorporated into regulatory guidance. Regulators could benefit from mechanisms that limit or closely monitor off-label use and thereby allow approval of drugs for narrowly indicated populations.

The Long Road To Health Reform Requires Bipartisan Leadership

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10: (1) make health reform a top legislative priority; (2) be leaders, not partisans; and (3) develop broad policy consensus but leave the policy details to Congress.

Disparities in Physician-Patient Communication by Obesity Status

This study aimed to examine variations in patient-physician communication by obesity status. We pooled data from the 2005-2007 Medical Expenditure Panel Survey (MEPS),_included only individuals who completed the self-administered questionnaire themselves, and restricted the sample to patients who received care from primary care physicians. We included a total of 6,628 unique individuals between the ages of 18 and 65 who had at least one office or hospital outpatient visit during the past 12 months. There are six outcomes of interest in this study. The patient-physician communication composite score is based on five questions that the MEPS adapted from the Consumer Assessment of Healthcare Providers and Systems Survey. The other five variables were: respect from providers, providers’ listening skills, explanations from providers, time spent with patients, and patient involvement in treatment decisions. The key independent variable was obesity. Bivariate and multivariate models such as ordinary least squares (OLS) and logistic regression were used to examine the relationship between patient-physician communication and obesity status. Multivariate models showed that obese patients had a reduced physician-patient communication composite score of 0.19 (95% CI 0.03-0.34, p=0.02), physicians’ show of respect OR 0.77 (95% CI 0.61-0.98, p=0.04), listening ability OR 0.82 (95% CI 0.65-1.02, p=0.07), and spending enough time OR 0.80 (95% CI 0.62-0.99, p=0.04) compared to non-obese patients. We found a negative association between physician-patient communication and patients’ obesity status. These findings may inform public health practitioners in the design of effective initiatives that account for the needs and circumstances of obese individuals.

Reconsidering the policy options to combat obesity

As the prevalence of obesity steadily grows, so too does our understanding of the threats that excess weight poses to both our individual health and our nation as a whole. With this information, there is a need now more than ever to reconsider the options we have to mitigate the health risks and costs of this growing epidemic. This includes, among other conversations, examining how employers can play a role in encouraging healthier habits through workforce-based initiatives and a reconsideration of the risk-benefit paradigm that informs the decisions of payers, regulators, and providers on this crucial issue.