Diet clinics are poised to benefit from a provision in the U.S. Affordable Care Act — aka Obamacare— that requires insurers to pay for nutrition and obesity screening, according to a recent report in the New York Times.
That’s good news for the doctors who oversee these facilities, but is it good news for food addicts?
It certainly could be. Healthcare professionals are positioned to make great strides in the field of food addiction. They could diagnose food addicts and coach clients through the rigors of detoxing from trigger foods. They could provide a healthy eating plan and could incorporate a support group to ensure ongoing recovery.
On the other hand, this funding could be a case of living off the fat of the land. If these same diet clinics are ill-equipped to recognize food addiction because they do not understand the nature of the disease, a large group of clients could have their recoveries derailed. Real lives could be lost to this often unrecognized, chronic and fatal addiction.
How can these clinicians help?
Let me start by offering these professionals a few guidelines for recognizing food addiction. First, it is important to know that food addiction is NOT synonymous with obesity. For a detailed discussion of the difference between obesity and food addiction, I refer you to my book Food Junkies: the Truth About Food Addiction.
Several sources provide guidelines for recognizing food addiction: the Yale Food Addiction Scale (YFAS), the Diagnostic and Statistical Manual of Mental Disorders (DSM, under “substance use disorder”), the American Society of Addiction Medicine (ASAM) and several self-diagnosing checklists published by 12-step food-related fellowships such as Food Addicts in Recovery Anonymous (FA).
At least one of these tools ought to be available (and used) by the clinics that stand to benefit from this funding: weight-loss doctors, physician assistants, nurse practitioners and all other first points of contact for any potential food addict walking into a diet clinic. Key questions, which I have paraphrased from these sources, to be asked of newcomers include:
- Do you find that when eating certain foods you eat more than planned? (YFAS)
- Do you eat to the point of physical illness? (YFAS)
- Do you find yourself developing an increased tolerance for certain foods or food amounts? (DSM)
- Do you find yourself neglecting your responsibilities at work, home or school as a result of your eating? (DSM)
- Do you experience craving when you give up favorite foods? (ASAM)
- Has your eating interfered with your interpersonal relationships? (ASAM)
- Do you eat differently in private than you do in front of people? (FA)
- Do you think about food or your weight constantly? (FA)
Unfortunately, nowhere in the NYT article is even one of these screening questions mentioned. Instead, we are told that most of the doctors hoping to cash in on the new ACA guidelines for treating obesity could “earn as much as $3,000 more a year for each obese patient.” Indeed, some medical weight-loss programs are charging close to $400 a month for “weekly counseling and medication,” and many are offering supplement “aids” such as vitamin shots, Botox treatments and unproven diet supplements including phentermine. We are also told that almost all of these programs are ineffective and have not shown sustainable weight loss for most participants.
Perhaps the most unsettling outcome of this opening of the doors to fat profits (pun intended) within the medical community is this: When an administrator from a large New England teaching hospital was asked recently why the facility did not offer treatment for food addiction — when it offers treatment for other addictions — the response was lack of interest. He explained, “We make too much money on bariatric surgery.”
I find it sadly ironic that insurance-funded medical weight-loss programs, reportedly bringing in $1 billion annually, are most likely no more effective than the no-cost approach offered by fellowships such as Overeaters Anonymous or Food Addicts Anonymous. Even if some of these groups don’t offer a workable solution, at least they get the problem right. These clinics don’t even recognize addiction when it walks in the door.