Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

After too many holiday treats and too little exercise, it's no wonder many of us have made resolutions to take better care of ourselves in the new year.

A few extra pounds can be lost as the holiday season winds down and we get back to our regular schedule. But for people who are either overweight or obese, getting to a healthy weight—and staying there—requires major lifestyle changes. For some, it may even involve surgery.

Being overweight is defined as having a body mass index, or BMI, of between 25 and 29. Individuals with a BMI of 30 or more are considered obese. This tool will help you calculate your BMI. Obesity is more common in women, and being overweight is more typical in men.

Being at an unhealthy weight affects more people each year. Obesity among adults has doubled in the last 25 years. Today, two out of three adults are considered to be overweight, and about 27 percent of Americans age 20 or older are obese, recent government data show. Even more troubling, about one in five children in the United States is overweight, according to government data.

Being obese or overweight puts you at higher risk for serious chronic or medical conditions, according to the U.S. Surgeon General and others. Obesity increases your risk for heart disease, high blood pressure, stroke, diabetes, and several types of cancer. Obesity also is linked to high rates of gall bladder disease and joint problems, like arthritis of the knee.

The good news is that dropping a modest amount of weight can make you feel better and improve your health. Losing between 5 and 7 percent of your body weight can reduce your blood pressure, lower the risk of diabetes, and improve cholesterol levels.

In recent years, a number of obese individuals have turned to surgery as a way to help them achieve a healthy weight. Known collectively as bariatric surgery, the number of these procedures has skyrocketed in the past decade. Young and middle-aged individuals accounted for the vast majority (85 percent) of the 121,000 surgeries performed in 2004. Patients who underwent surgical treatment for obesity were also more likely to improve their health compared with those who did not choose surgery. These findings come from a report by my agency, the Agency for Healthcare Research and Quality (AHRQ).

Undergoing surgery to produce major weight loss is a big decision—and one that you should make carefully. In particular, it's important to choose a surgeon and a hospital that can show they've had good outcomes in these types of procedures. Ask for this information and details on the risks involved before you have surgery.

When it comes to your weight and your health, what guidance should you expect from your doctor?

One blue-ribbon task force has evaluated evidence that shows that intensive counseling on diet and exercise can help obese people change their behavior. This can produce modest weight loss for a year or more. Outcomes, such as lowered blood pressure, show that this approach offers real health benefits.

Based on this evidence, the U.S. Preventive Services Task Force recommends that primary care doctors offer intensive counseling to obese adults. The Task Force is a panel of experts that reviews medical evidence to find out which tests and medicines have been proven to work to help prevent health problems or detect them early so they can be treated effectively.

Intensive counseling and skill building can also help obese children and teens lose weight or prevent additional weight gain, a new AHRQ report found. Children and teens who took part in these programs, which typically met once or twice a week for up to a year, weighed between 3 and 23 pounds less than those who did not participate. Successful programs included tips on improving diets and increasing physical activity and taught skills, such as goal setting and problem solving.

Regardless of your age, there are good, evidence-based approaches to help you lose weight and keep it off. The first step is for you to talk to your doctor. A discussion about the best approach for you can get you on a path to better health for the coming year and beyond.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
Obesity on the Rise in the U.S  (Transcript)

U.S. Department of Health and Human Services, healthfinder.gov
Body Mass Index: Adult
http://www.healthfinder.gov/HealthTools/Calculators.aspx/

National Center for Health Statistics, Centers for Disease Control and Prevention
Prevalence of Overweight and Obesity Among Adults: United States, 2003-2004
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm

National Center for Health Statistics, Centers for Disease Control and Prevention
Prevalence of Overweight Among Children and Adolescents: United States, 2003-2004
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03.htm

Office of Surgeon General, U.S. Department of Health and Human Services
The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity
http://www.surgeongeneral.gov/topics/obesity/

Agency for Healthcare Research and Quality
Bariatric Surgery Utilization and Outcomes in 1998 and 2004
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp

Agency for Healthcare Research and Quality
Behavioral Modification Programs Help Obese Children Manage Their Weight
http://www.ahrq.gov/news/press/pr2008/chweightpr.htm

U.S. Preventive Services Task Force
Screening and Interventions to Prevent Obesity in Adults
http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm

Current as of January 2009
Internet Citation: Ready to Lose Weight in the New Year? Experts Offer Guidance for Adults and Children. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/010609.html