Monday, April 16, 2012

My responses to NY Times Opinion piece.

An "Opinion" piece ran in Monday's NY Times in which six individuals weighed in on what it will take to address the poor eating habits of Americans.

The link to the NY Times piece is at end of this blog.

In the comments section, I posted the following three responses.

Part 1: After reading the views about improving healthy eating, one subject was untouched--the role of physicians, nutritionists, and registered dietitians (RDs) in correcting American's poor eating habits. Most Americans continue to trust their physicians and the advice they receive. A recent study demonstrated that patients are likely to heed nutritional advice when given. Nutritionists/RDs have the most relevant training of anyone to address patients' dietary habits. Yet, most health insurances do not reimburse for such services. Medicare primarily only pays for nutritional therapy for diabetics and end stage kidney disease. Due to no reimbursement for nutritional services, physicians do not employ nutritionists/RDs in their practices. This may be the most shortsighted aspect of our healthcare system. In 2011, Medicare added an Annual Wellness Visit. This visit requires completion of a health risk assessment, and appropriate referral as needed. Often, that need centers on nutritional services. During a July 2011 conference call regarding the Annual Wellness Visit with Centers for Medicare and Medicaid Services (CMS), I asked how is that referral to be successfully made given there is no reimbursement available to cover it. The response was that I had asked a good question that needed to be addressed. During a similar conference call last month, the issue was unaddressed and there is still no solution.

Part 2. Patients developing chronic diseases, i.e. diabetes and heart disease, generally have poor access to a nutritionist or RD. Absent insurance coverage, they must pay out of pocket. As few seek such services, dietitians need to charge more to cover costs. Yet, when diabetes, heart disease or other diet-related diseases, e.g. dementia, cancer, strokes etc., emerge, then the floodgates open and we pay. From 1989 to 2010, I led an organization that provided medical care to over 5 million seniors and saw what happens to many Americans who live an unhealthy lifestyle, get sick, and are institutionalized. Lifestyle intervention could have made a difference because as the CDC states, "the evidence for the power of prevention is now indisputable." In response, I opened in October 2011, MDPrevent, a primary care/preventive medicine/education center committed to helping patients stay and get healthy. We group doctors, nurse practitioners, health psychologists, nutritionists/RDs, fitness instructors, and health educators to facilitate affordable nutritional seminars, weight loss, mindfulness and cooking classes, diabetes education, life-transformation classes, fitness and yoga classes. So while others debate how to get people to eat healthier, we are busy doing it. If insurance companies started covering lifestyle modification programs and nutritional services, we could all start focusing on prevention instead of treatment.

Part 3. Despite this apparently righteous debate about improving diets in America, I fear that this discussion will be put to a more nefarious use--support for dietary supplementation. The marketers of such products, despite the absence of supporting evidence for their value (and most recently evidence of heir harmfulness), often argue that Americans eat poorly and need to supplement to maintain good health. Most Americans despite their obesigenic and otherwise unhealthy diets, get sufficient vitamins and minerals from the numerous fortified foods they consume. Yes, there is a huge problem with the nature of food most people eat, but the answer is not increased supplementation.

Link to NY Times article:

1 comment:

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