In the final panel of the workshop, Marsha Schofield, senior director for governance and nutrition services coverage, Academy of Nutrition and Dietetics, closed the discussion by emphasizing the importance of communities and person-centered care in the treatment of obesity. “How do we take wonderfully stimulating conversations that happen at forums like this and do something with it—in the communities?” she asked.
The first task, Schofield said, is to involve communities, not just individuals. “It is essential,” she asserted, “when we want to spread and we want to scale [an intervention], that we are inclusive.” The people who need help and support are a very diverse population, she observed, and one solution will not work for all. “We have to make sure,” she said, “as we work in communities to scale these things and spread them, that we have different options” available. Thus, she elaborated, a diabetes prevention
program might help one person; a Weight Watchers program another; and interprofessional, multicomponent therapy another. “We need options,” she said, even within each intervention, such as individual therapy, group therapy, and technology-based approaches. Working with communities requires time, conversations, relationship building, and trust, she noted, but “it is essential. It is more than buy-in to a concept. It is building a design team that is inclusive of all the parties.”
The variety of needs and communities provides ample opportunities to be creative, Schofield observed. In this way, she suggested, solutions can be based on the unique needs of each community. At the same time, she added, communities have commonalities that need to be considered in spreading and scaling up approaches, such as a need to reduce disparities. “There are places where people go to school,” she said. “There are places where people get some kind of connection with the health care system. There is a place of worship. There is a place where people get their food. We can bring our approaches into those places. . . . We can tap into those resources and partner with those groups.”
Schofield observed that some point to a lack of providers as a limit on obesity treatment, and others point to challenges in the payment and delivery systems for supporting treatment, but she offered another perspective. At any given moment, she said, only a subset of a population is ready to access treatment, and this casts the supply–demand balance in a different and perhaps more manageable light.
Schofield added that although the task of scaling and spreading an intervention can seem overwhelming when there is a significant need, the concept of “eating the elephant one bite at a time,” can be helpful. That is, she suggested, start with one segment of the population or work with one payer to pilot a program, acknowledging at the start that the program will not be addressing everything for everyone. She suggested these “small bites” will get infrastructure in place as scale-up is initiated.
Schofield also emphasized the need to maintain integrity as obesity treatment approaches are spread and scaled up. As programs are adapted for individuals and communities, she observed, practitioners can be tempted to cut corners to create a more favorable return on investment. “I caution us not to throw out all of the elements that are the keys to the success that we know” has occurred, she said. She suggested that using trained experts and evidence-based interventions can maintain the integrity of obesity treatments.
At the same time, Schofield noted, obesity treatment needs to be oriented to the needs of individuals. As with community involvement, she observed, that means getting the people who will be served involved in the design of implementation. “We may be the experts on what works,” she
said, “but we need those people, those patients, to be our experts on how do we implement it.”
Schofield closed by asserting that successful obesity treatment requires reaching individuals with the right approach, the right provider, and the right message delivered with the right language at the right time. “There are lots of things to get right,” she said. “Our challenge is to think about the matchmaking between all of those things, and as we spread and scale, trying to get all of those things right. It is complex, but it is doable.”
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