The assumption that the doctor knows best and that health care services should be protected from government meddling ranks right up there with protecting the flag as one of those sacrosanct American traditions. Millions are spent annually by the health care lobbies to sustain resistance to government intervention in medical care.
In one category of health care, the treatment of obesity, there has been an abundance of confusion, abuse of patient care and exaggerated claims. The laissez-faire tradition that involves keeping government at bay is doing more harm than good for qualified health professionals and the consumers in their care. It is time to regulate the diet industry.
Losing weight is big business, $33 billion per year, according to Rep. Ron Wyden (D-Ore.) and his subcommittee, which is investigating the diet industry. One quarter of Americans are overweight. Most struggle with a perpetual diet while spending money on an endless variety of weight-loss products and services.
My life as a physician is concerned substantially with the incurable disease of obesity. I am reluctant to add still more paperwork to the flow that crosses my desk, and I know enough about how the government works to know that it is not likely to be good at regulating health care.
I am convinced, however, that the diet industry can be regulated with a few relatively simple procedures without falling into the trap of government meddling.
1. Establish a national commission (yes, another one) appointed by the Secretary of the Department of Health and Human Services to formulate reasonable standards of care, characterize the types of services provided, establish a non-governmental accrediting agency, and then go out of business.
2. Programs and providers may elect to be accredited according to standards established by the accrediting agency, or choose not to and answer to their patients. The programs should specify the types of services they provide and the qualifications of the providers. The accrediting agency should not tolerate the mislabeling of professional skills, the promotion of exaggerated claims or the misrepresentation of services provided.
3. The programs will need continuing accreditation and should pay for the certification process, very much like the program for hospital accreditation that has been in place for decades. The system should be financially self-sufficient and not require government funds.
4. The accrediting agency should provide guidelines for consumers about kinds of services and how to select them. Not all people require the same kind of assistance. It is a waste of resources for a healthy young person 15 pounds overweight to undertake an intensive medical program with complex nutritional intervention and psychotherapy. But it is a dangerous risk of human life for a 350-pound patient with diabetes and cardiac disease to be managed by a counselor who offers compassion but does not know how to interpret an electrocardiogram. Patients should be able to identify who is providing the care, the intensity and the cost of the program and the skills of those involved.
A certification program will benefit competent health care professionals and millions of obese people who want to establish a method of managing their disease.
Arthur Frank is a Washington physician and an assistant clinical professor in the department of medicine at George Washington University School of Medicine.
Second Opinion is a forum for points of view on health policy issues.