Thursday, October 22, 2009

Learning How to Treat Obesity from a UK NHS Program

In our October 14, 2009 blog post, we discussed the Chronic Care Model as a tool to treat obesity. The model was developed by the MacColl Institute for Healthcare Innovation. Since obesity is viewed as a chronic illness, the model might be used to fight obesity. In the model, the obese patient plays the central role in the model. Now, a UK program is confirming the importance of the role the patient must play in obesity treatment.

The UK program is about one year old. The program is an “NHS [National Health Service] nurses led service” program. As the description indicates, nurses lead the program. The program emphasizes patient education as a way for the patient to establish a strategy for losing weight. Indeed, in the UK program, as in the Chronic Care Model, an educated patient with assistance from trained professionals can lead to weight loss.

As we mentioned before, the Chronic Care Model consists of six elements. These elements are: community resources and policies, the provider’s health care organization, case management, delivery system design, decision support, and self-management. And the self-management aspect of the Chronic Care Model is the most important element of the model.

It was pointed out in our Chronic Care Model blog post that some of the most important functions of the model are best carried out by trained non-physicians. And again, the UK program’s nurse leadership supports the belief that non-physician professionals can play a significant role in the treatment of a chronic illness such as obesity.

It appears that much is being learned about non-surgical, non-drug approaches to treating obesity. If research can continue to help improve these weight loss approaches, more obesity patients will be able to successfully deal with obesity on a long term basis. Of course, bariatric or weight loss centers should follow research in this area, and make use of applicable research results.

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Wednesday, October 14, 2009

Using the Chronic Care Model to Treat Obesity

Obesity may be viewed as a chronic illness. Therefore, tools used to successfully treat chronic illnesses can be used to treat obesity. An effective tool for treating chronic illness is called the Chronic Care Model. The Chronic Care Model was developed by the MacColl Institute for Healthcare Innovation. The institute is based in Seattle, Washington. The institute developed the model to treat those illnesses that require an ongoing relationship between the ambulatory patient and the health care provider.

The model was developed more than a decade ago. In designing the model, the developers researched literature to uncover methods that could be used to improve the treatment of chronic illnesses. Over time, the model evolved to contain six key elements. These elements are: community resources and policies, the provider’s health care organization, case management, delivery system design, decision support, and self-management.

The first of the six elements is community resources and policies. This means that the health care provider should make use of existing community resources. Further, the provider should work to institutionalize policies that improve care. In making use of community resources, for example, a bariatric center could partner with a gym in the community to provide exercise to patients.

The next item on the list is the provider’s health care organization. Among other things, this item stipulates that the provider’s health care organization should actively support improvements in health care. And the provider’s organization should emphasize the use of quality measures in the application of health care.

Case management, the next list item, is meant to indicate that the provider should work with the patient to enhance the patient’s self-management. Self-management will be discussed below. Case management also entails follow-up to make sure the treatment is working. Case management also includes an effort to help guide the patient through the health care system.

The delivery system design is the next element on the list. It is essential, for example, that the delivery system be designed so that necessary resources be made available to the patient. In fact, implementing the delivery system so that both the provider and the patient have access to resources is important. In the system, evidence based treatment methods should be used. And many of these treatment methods ought to be delivered by non-physician members of the provider team. Because in some cases, it has been found that non-physician members can deliver certain services better than the physician.

Next, we have decision support. Evidence-based guidelines must be part of the health care provider's organization. Established education methods should be employed. And treatment guidelines and clinical information should be shared with the patient.

Last on the list is self-management. Indeed, it has been found that self-management is a necessary part of the Chronic Care Model -- more so than any other element. In self-management, the patient must be viewed as the central player in the ongoing treatment of the chronic illness. And as part of the process, the provider must agree to relinquish some control to the patient.

Since the introduction of the Chronic Care Model, efforts have been made to determine if the model improves health outcomes and is cost effective. Although more work needs to be done to determine the cost effectiveness of the model, published reports appear to indicate that by using the Chronic Care Model, health care organizations can improve the treatment of chronic illness.

Since overweight and obesity may be viewed as a chronic illness, The Chronic Care Model is applicable in the treatment of the illness. It has been shown that for long-term success, a strong ongoing relationship between the individual attempting to lose or control weight and the organization providing the weight loss or weight management service is of utmost importance. And the Chronic Care Model emphasizes this relationship.

Indeed for obesity treatment, weight loss centers should review elements of the Chronic Care Model, and try to implement as many of the model's elements as possible, with an emphasis on self-management.

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Monday, October 5, 2009

GENova Biotherapeutics Inc. and Bridge Bioresearch Plc. to Look for Obesity-Cancer Link

We now know that obesity is highly correlated with a number of illnesses, including some cancers. Therefore, efforts that might shed more light on the relationship between cancer and obesity can be useful. New York based GENova Biotherapeutics Inc, which has a research focus on cancer, will collaborate with the UK based company Bridge Bioresearch Plc., which has a focus on obesity. The two companies will try to find links between cancer and obesity by sharing their research results.

Obesity has been found to play a role in a number of ailments. It is well accepted that these ailments include high blood pressure and high cholesterol. Moreover, The Mayo clinic did a study and determined that obesity contributes to the need for hip replacement. And some experts indicate that there is a link between obesity and Alzheimer’s disease.

Further, researchers in the UK suggest that obesity is a bigger health risk, today, than smoking. In the UK, it is estimated that there might be as many as 19,000 British cases of cancers per year resulting from obesity. Finding links between obesity and cancer is almost as important as the link discovered between smoking and cancer, since obesity is associated with a number of cancers.

According to the National Cancer Institute (NCI), a U.S. government organization, obesity is related to a number of cancers. These include: "colon, breast (postmenopausal), endometrial, kidney, and cancer of the esophagus." According to the NCI, the link between cancer and obesity is not known. In fact, the NCI goes on to say, the link might be different for different cancers. And the NCI has ongoing studies to determine what these links are.

The collaboration between GENova Biotherapeutics Inc. and Bridge Bioresearch Plc. may add to results coming out of the NCI studies and other studies investigating the link between cancer and obesity. In fact, health care organizations that offer both weight loss treatment and cancer treatment might also add to the obesity-cancer link knowledge base.
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