Facing Opioids and Obesity as a Holistic Approach

Michael Thompson: Looking holistically at what’s going on in population health, there are 2 areas that continue to be major and, in some instances, growing challenges. And I think back to how we got a handle on substantial improvement in the smoking rates in the country. And it wasn’t 1 thing. It was a lot of things that happened over a period of years. And we have 2 persistent key issues: obesity and opioids. What are your thoughts? What do we need to do there? I’ll bet it’s not 1 thing. But what are some of the things we need to do if we’re going to get our hands around those 2 issues?

Andrew Crighton, MD: I’ll let Bruce take that one.

Michael Thompson: Go ahead, Bruce.

Bruce Sherman, MD: No easy answers. I think from an opioid standpoint, there’s the piece of this that’s related to overprescribing both in terms of frequency and volume of opioids through the current healthcare system. And I think we’re taking steps to reasonably address that. I think the bigger issue is how the current environment is creating, especially for individuals in lower-income categories, sustained depression and stress. Opioids represent, for some individuals, a very attractive escape from that. And until we address some of those underlying issues, we have a challenge on our hands.

Andrew Crighton, MD: Yes, I would agree. I think the social support is important. The purpose is driven; those people are probably less likely to rely on an outlet such as opioids. When you look at the obesity aspect, that is much more complicated than people think. People think, “Oh, we’ll just eat less, exercise more,” but there are a lot of genetic components, too, that are being identified. So it’s more complicated than just, and so it’s probably a symptom of other things going on versus an actual disease. I mean, it leads a lot of things, but I think it’s a symptom of other things going on, and it’s multifactorial.

Patricia Haines: Our population suffers the same way others do: less from the opioids honestly, probably less than an average population, but certainly from obesity and just lifetime habits. And that’s behavior modification that if we had it, that would be key. I will say that we’ve had fair success with bariatric surgery. That’s become much more acceptable. I remember talking to a patient once who said it just felt like such a defeat to her that it was what she had to do. And I don’t think patients are feeling quite that way as much. I think that’s because they’re going through steps beforehand, and it’s more acceptable, and the outcomes are pretty decent. At least they have been with our handful of patients.

Michael Thompson: I’ve heard people say that in the case of obesity, in terms of our bias around individuals with obesity, we are where we were with mental health 10 years earlier, right? There’s a little bit of a blame element to this, and yet there is a physiology that is continuing some of these issues. And I agree with everybody; it’s not a simple one. I’d also say the lesson from smoking is that it’s not going to be 1 thing. It’s going to be everybody putting oars in the water, pulling in the same direction, and that includes collaborating—public and private sectors together.

Patricia Haines: Well, the various communities that have imposed taxes on sugar drinks, that struck me as a no-brainer. There was outcry around that, but that’s 1 of those little pieces. That’s a contributor, so we’re going to make it a little harder to get, just like cigarettes. A contributor, so we’re going to make them a little bit more expensive. We’re going to outlaw them in certain places. I think you’re right.

Michael Thompson: Just to wrap up, it appears to me that we don’t have it licked here in terms of population health, but there are a lot of good things that are happening. And this broadening, looking at it more holistically around total health and well-being, is a positive move. I think this orientation toward personalization and patient centricity is a key theme of what holds promise. And again, it’s not going to be 1 thing. It’s going to be multiple things working together. I think the other thing we shouldn’t forget is the issue of culture, right? This is not an outsourced, easy plugging in of a program where it all goes away. It’s really starting to build a culture around health and well-being, and it manifests itself right through the supervisors and the leadership of the organization.