1. 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.

  2. The commission would identify different levels of weight-loss care and develop reasonable standards within each of these levels.

  3. 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.

  4. 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.

  5. 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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