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Obesity In A Rural Setting

Cheryl Clark, for HealthLeaders Media, July 29, 2009

"Rural residents tend to eat diets higher in fat and calories, exercise less and watch more television, all of which can contribute to unhealthy weight gain," according to the Obesity and Weight Control section of the Rural Assistance Center.

So what if whole communities, led by their doctors, nurses, and other health professionals, just got together and said they'd give it a try? That's a suggestion of Nick Yphantides, MD, now consulting medical director for the San Diego County Health and Human Services Agency, who lost 270 pounds himself after realizing his ineffectiveness in trying to counsel his patients to lose weight.

It seems like there's a potential win, win, win situation here.

Maybe they could lead exercise activities several days a week that their patients could join. Or perhaps they could amass support groups. How about "Biggest Loser" competitions in their hometowns?

Given the ultimate increase in the cost of care that often is absorbed by the healthcare system, maybe there could be financial incentives for health workers to meet and maintain their goal?

A recent New England Journal of Medicine paper discussed a successful experiment in Philadelphia to get long-time smokers to quit. In a clinical trial, 878 employees who smoked cigarettes were randomized to either receive information about smoking cessation or to receive that information plus financial incentives if they succeeded in quitting for six months. The project was financed by the Centers for Disease Control and Prevention and the Pennsylvania Department of Health with cooperation from a large multinational company's employees.

Those in the second group received $100 for completing a smoking cessation program, $250 for cessation of smoking as confirmed by a biochemical test, and another $400 if they were still clear of tobacco, as confirmed by that test, six months later.

The results? Those who received the full $750 were three times more likely to have stopped smoking than those who only received information about quitting.

Could something like that be translated to a weight loss campaign? Say, $500 to get one's weight to an optimal level by the end of a year? What about $1,000?

Heck, it'd still be cheaper than making taxpayers spend that extra $1,429.


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Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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