Recast Obesity as a Behavioral Rather than Medical Condition Flip Nexus of Care to Behavioral Professionals

"To treat malaria, go to a physician. To prevent it, consult a mosquito controller." Documenting the severe medical consequences of obesity can help motivate patients, practitioners, and policy makers to attend to the epidemic. However, despite its numerous and severe physiologic medical sequelae, the origins of obesity (and the recent increase in its prevalence) are largely social and behavioral. This raises questions about our current treatment paradigm. The medical profession has been (perhaps de facto, rather than by design) designated as the primary gatekeeper charged with stemming the epidemic. In the current model, behavioral and nutritional professions have largely been cast as secondary resources—as treatment adjuncts. This has considerable implications for how we conceptualize obesity and how we reimburse those who care for it. Given the behavioral origins of the condition, perhaps we should reconsider the nexus of professional responsibility. A model that casts behavioral professionals as the first line in clinical care would be more consistent with the underlying etiology. This paradigm shift, however, would require dramatic alterations in how managed care reimburses behavioral counseling, including a de-emphasis on the comorbidities of obesity and a greater focus on the underlying behavioral and psychological causes as well as alteration for how the public perceives the role of behavioral and psychological professions. As part of this reconceptualization, individuals, rather than being viewed as suffering from obesity, might be seen as having a particular eating or activity problem. Obesity becomes the symptom rather than the disease. Creation of an obesity treatment subspecialty within psychology and/or health education, not unlike what has been done with HIV and substance use specialists, should be considered.

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