EDITORIALS The Challenge of Obesity Management in Primary

Obesity is increasingly recognized as both a chronic disease for the individual and an epidemic of alarm-ing proportions for our population. Medical con-cern about obesity does not relate to attractiveness; rather, it focuses on the health impact of excess body weight. Considerable evidence now supports the fear that excess body weight is associated with diminished likelihood of longevity and seriously increases morbidity during life. 1 Thus far, however, dangers posed by obesity have not been matched by effective medical responses. Like hypertension, hyperlipidemia, and sleep apnea, obesity can be legitimately viewed as a chronic disease, requiring long-term treatments and sustained effort. The current challenge posed by obesity management is partly the dearth of ef-fective clinical treatments. As with earlier days of treatment for hypertension or cholesterol, increas-ingly effective treatments are coming, but individ-ual treatment successes are possible. Efforts to manage obesity are further challenged by the necessary reliance of available treatments on complementary behavior modifications. To the ex-tent that obesity-related behaviors can be effec-tively treated, success often occurs in the context of a specialized program. Because efforts to change behavior require considerable interaction time, the primary care physician is disadvantaged in efforts to address this condition. Limitations by payers on the time that can be spent, either by the primary care physician or by associated practitioners, to address these behavioral concerns mean that the practitio-ner is under great pressure to do much in a short time. Furthermore, many payers will not compen-sate for such treatments, and the practitioner, al-though often sympathetic with the goal of im-proved body weight, feels unable to meet the patient's needs