From The Founder's Desk
columnist: Walt Thiessen

Topic: Health Care
Ignoring the Root Causes of Obesity and Other Major Health Problems

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The latest CDC study suggesting discussing medical costs for obese patients perpetuates the wrong solution for the problem, a governmental solution that must fail in the long run.

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by Walt Thiessen
(libertarian)
Monday, July 27, 2009

ABC News among other news sources today is reporting that obese patients incur 43% higher medical costs than non-obese patients, and overall obesity-related medical conditions account for 9% of all medical spending. Their source is a CDC study. The study's lead author, Eric Finkelstein, is quoted by ABC as saying, "Although societal changes are necessary, physicians can play a role in curbing the obesity epidemic by talking to their patients about weight loss in a clear manner so the patient really understands their health risks."

In this manner, by treating the issue as one primarily of proper patient education, Finkelstein actually perpetuates a long-hidden problem, which I will dare to put forward here. Put aside for a moment research which suggests that obesity may have genetic properties. Put aside all the diet plans, the weight watcher plans, the Atkins Diet, Jenny Craig, etc., etc. Put aside everything you thought you knew about obesity. Put it all aside, and consider something different for one moment.

Is it possible that obesity has a much more sinister root, one which gets almost no attention? The answer is a resounding yes. That root which it likely shares with many other medical problems has eight contributing "branch roots" that combine together to cause problems for people: (1) patient physically abused, (2) patient verbally abused, (3) patient sexually abused, (4) a family member in prison, (5) mother physically abused, (6) a family member with a drug or alcohol problem, (7) a parent was missing, and (8) where someone in the family was chronically depressed, mentally ill or suicidal.

These factors were measured in a study instigated by another study originated by Dr. Vincent Felitti, then chief of Kaiser Permanente's Department of Preventive Medicine in San Diego., as reported by Jane Ellen Stevens in the Sacramento Bee, July 31, 2005. He released the results of his seminal study in 1990, and those results received widespread rebuff and pooh-poohing by his peers in the medical community. He developed the study to figure out why obese patients, even those successfully losing weight, so often leave whatever program they're succeeding with and revert to their previous, high weight levels.

The study began with a simple patient medical questionnaire in which Dr. Felitti asked a respondent the wrong question. He intended to ask, "How old were you when you were first sexually active." Instead, he misspoke and asked, "How much did you weigh when you were first sexually active?"

The answer he got was, "40 pounds."

Stevens wrote, "He thought he'd misheard. He asked again. She gave the same answer, began sobbing, and added: 'It was with my father.'"

It was the first instance of sexual abuse he had heard of in 23 years in practice. About 10 days later, he got a similar response from another interview. Pretty soon, he began to ask more pointed questions in this regard, and started getting consistent responses that talked about sexual abuse in the respondent's background.

Concerned that his own bias might be causing the unusual response rate, he asked five medical colleagues to do the next 100 surveys. The results remained the same. They found a staggering amount of sexual abuse among the obese patients he surveyed.

No wonder his medical colleagues rejected his conclusions when he submitted the results of his survey! They simply refused to believe his claims. On the other hand, "Felitti began to realize that obese people didn't see their fat as a problem. For many, it was a solution."

He later received CDC assistance with a related study that found that when at least four of the eight factors I listed above appeared in a person's personal history, the person was also 390% more likely to be a smoker (and 390% more likely to have pulmonary lung disease), 240% more likely to suffer from hepatitis, 250% more likely to have a sexually transmitted disease, 460% more likely to be suffering from depression, and 1220% more likely to have attempted suicide.

Those people with six out of eight factors in their personal background had a "4600% increase in the likelihood of becoming an IV drug user. Most startling of all: 64% of the study participants had experienced one or more categories of adverse childhood experiences."

The results of this survey were presented in 1999, and as I said, the survey was conducted by the CDC.

So here's the question: why is the CDC's most recent study pushing this information aside when it conducts its current study? Why is it concentrating on physicians presenting medical risk information properly to obese patients, rather than focusing on the abusive histories of obese people? The answer is very simple. The CDC can do nothing about root causes of obesity. So, to continue to justify their funding, they concentrate on what they can influence: physicians.

This excellent example clearly illustrates government incompetence and impotence when it comes to solving "social problems" which it so loves to address. It can't do anything about the fact that so many people are likely overweight because of their personal histories of abuse, so they push it aside.

Unfortunately, the rest of society tends to follow the government's (and the CDC's) lead. The result is that almost no one pays any attention to root causes. Instead, most experts focus on addressing symptoms.

The truly ironic thing is that government actually could do something in this case. They could use their immense bully pulpit to start trumpeting the incidence of sexual, physical, and verbal abuse in causing later medical problems. Of course, to do this they'd have to abandon the idea that they can lead significant change in these issues. It would mean changing emphasis to an individually-based approach to solving these problems, rather than a governmental approach. This is why the CDC and the Federal government will never take this approach.

The irony is astonishing. The lesson is one to be remembered by all who advocate greater government involvement in health care. Governmental involvement will likely make the overall health care situation much, much worse by ignoring the fact that government is actually powerless to achieve positive, productive improvement in health care.

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©2009 Walt Thiessen, all rights reserved. You must have written permission from the author in order to republish this work.
Published: Monday, July 27, 2009
Last modified: Wednesday, July 29, 2009

The views expressed in this article are those of Walt Thiessen only and do not represent the views of Nolan Chart, LLC or its affiliates. Walt Thiessen is solely responsible for the contents of this article and is not an employee or otherwise affiliated with Nolan Chart, LLC in his/her role as a columnist.

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