Medical specialists tackle heavy problem of obesity

Family practitioners can't always deal with the problems.
HAMPTON, N.H. (AP) -- When Milton Martin Jr. decided he was past due to lose 30 pounds, the former body builder and college football player couldn't bring himself to join a diet center.
"I don't function well in group therapy," he said, adding that he'd tried Weight Watchers and hated the meetings.
The 64-year-old accountant wanted more science and less socializing. He also wanted a plan that addressed all of his concerns -- including his escalating cholesterol -- not just his belly.
Now he sees Dr. Jennifer Warren, one of a small but growing number of physicians nationally who are specializing in weight management after their family practices were overwhelmed by patients with weight-related health problems.
"Primary care is preventive medicine. This really is the ultimate preventive medicine," said Warren, who left her general practice in February to open Physicians Healthy Weight Center, a Hampton obesity clinic.
"That's what got me started in this direction," the 39-year-old said in a recent interview. "So many of the medical problems I was treating in family care were weight-related."
Worked for him
Three weeks into his treatment, Martin's cholesterol was down and he'd lost 12 pounds, thanks to low-dose appetite suppressants and calorie-cutting. And he doesn't miss the meetings.
With two-thirds of Americans now overweight and at greater risk for heart disease, diabetes and certain cancers, many in the medical community want to redefine the role doctors have in helping people slim down.
Doctors say the pressures of general practice -- which can limit time with patients to mere minutes -- and a lack of specialized training make it difficult to treat obesity in a primary care environment.
They say treatment involves not only creating individualized diet and fitness plans, but also assessing serious health concerns and addressing the underlying emotional and psychological issues that contributed to the weight gain.
"In eight minutes you can't undo all that stuff," said Peter Vash, a Los Angeles doctor who has treated obesity for 25 years.
Though often associated with gastric surgery, a procedure that reduces the size of the stomach, so-called bariatric medicine includes a gamut of treatments, from special diets to counseling to prescription drugs.
The impetus for change comes mostly from medical schools, according to Dr. George Blackburn, associate director of Harvard Medical School's nutrition division.
Medical students and young doctors are demanding to know more about nutrition and weight management, which previously was absent from most curricula, he said.
"We always ask physicians whether they see obese patients in the practice. They just laugh at us and say at least half," said Beth Little, executive director of the American Society of Bariatric Physicians.
How many specialists
Head counts of bariatric physicians are imprecise.
Little's group has 1,104 members, an increase of 165 from two years ago. The American Board of Bariatric Medicine has 236 certified physicians, and expects to add another 50 this year. Most years the increase has been around 30.
Though most insurers offer discounts for fitness and diet programs and cover nutrition services and even gastric surgery, coverage for services such as Warren's is spotty, making it hard for doctors to get into the field.
Warren charges $95 for the first visit, which includes an exam, creating fitness and diet programs, and monitoring and treating any related health problems. Monthly appointments thereafter are $75.