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OCR for page 234
Weighing the Options: Criteria for Evaluating Weight-Management Programs D Accrediting Providers of Weight-Management Services Arthur Frank, M.D. The weight-loss industry is largely unregulated. Health-care providers are required to maintain their own licensure, but commercial and nonprofessional programs have essentially no license or regulatory requirements. Anyone can provide weight-loss services in almost any context. Skills, training, and the maintenance of standards are not required, monitored, or assessed in any way. Accreditation systems have been successful in hospitals, colleges, and universities, and in many other aspects of health care. Typically, these are voluntary accreditation systems, but since government agencies, insurance companies, and many physicians and consumers would not tolerate an unaccredited hospital (or college or university), no hospital could survive without accreditation. I believe such a system could be made to work in the control of weight-loss programs. Without much involvement of government agencies, a voluntary accreditation system could be established as follows: COMMITTEE'S NOTE: In Chapter 1, we describe several efforts and initiatives to influence and regulate the practices and advertising claims of the weight-loss industry. Committee member Arthur Frank believes strongly in a voluntary accreditation system for weight-management programs to accomplish these goals. While the committee does not endorse Dr. Frank's proposal as described above, we feel it represents a point of view that merits wider attention and debate.
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Weighing the Options: Criteria for Evaluating Weight-Management Programs A national commission could be established by an appropriate authority to formulate reasonable standards of care, to characterize the types of services provided, to establish a nongovernmental accrediting agency, and then to go out of business. The commission would identify different levels of weight-loss care and develop reasonable standards within each of these levels. Programs and providers may elect to be accredited according to these standards or choose not to be accredited and then answer to their clients. The programs would specify the types of services they provide and the qualifications of the providers. The accrediting agency would not tolerate the mislabeling of professional skills, the promotion of exaggerated claims, or the misrepresentation of services provided. Much like the system of hospital accreditation, the programs would pay for the privilege of accreditation and would need continuing recertification at appropriate intervals. The system should be financially self-sufficient and not require government funds. The accreditation system should be able to provide guidelines for consumers about the kinds of services and how to select from among them. Overweight people should be able to identify who is providing the care, the intensity and cost of the program, and the skills and training of those involved. Regulators, particularly those involved with hospital regulation, have questioned whether there would be enough incentive in such a system to pressure weight-loss companies into participating, particularly when the sanctions of withholding financial benefits are not available as a weapon. It is worth considering whether the marketplace would provide the needed incentive. There is sustained and intense competition among weight-loss companies. Each is looking for an edge in its direct promotions to consumers. Perhaps many would consider this certification to provide significantly better leverage in reaching consumers than traditional flashy advertising promotions alone. Perhaps, also, a newly reformed health-care system, with a more enlightened approach to the disease of obesity, could require that benefits be available only to programs that are certified—the kind of leverage that made hospital accreditation mandatory and universal.
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