By Dr. Jaan Sidorov

First Posted at Disease Management Care Blog on 6/19/2013

Dr. Jaan Sidorov, host of Disease Management Care Blog
Dr. Jaan Sidorov, host of Disease Management Care Blog

Mrs. Smith (name changed) was overweight.  She knew it and her physician, the Disease Management Care Blog, knew that she knew it.  Since the DMCB was one of the two persons on the planet who knew her true weight, she could talk to it behind closed doors about diet, exercise, fads, over the counter meds, prescription appetite suppressants and even bariatric surgery.

What the DMCB quickly discovered was that Mrs. Smith’s weight-loss goals were not only unrealistic but, like many women struggling with weight, driven more by the prospect of how she’d look in a bathing suit than any real health benefit.

Mrs. Smith wasn’t alone. This seminal study demonstrated just how unrealistic women’s weight loss goals (in the range of 50 lbs.) can be.  Think of the popularity of The Biggest Loser and it’s easy to see why persons think thinness is just a matter of a few months of dieting and exercise, and that being skinny leads to health and happiness,

Easy, right? 

DMCB readers know otherwise. That’s why they’re not going to be impressed by the tone of this May 24 Reuters article on worksite wellness.  RAND, in a not-quite released report to Congress, examined the impact of several employee based programs and found, in the words of the Reuters reporter, only a “modest effect.”  Average weight loss was “only” three lbs., tobacco cessation rates were significant but “short term,” average cholesterol levels were unchanged and reductions in health insurance claims expense failed to achieve statistical significance.

Researchers have known for years that conservative dietary and lifestyle therapy typically results in weight loss in the range described above. In addition, cholesterol reduction as a primaryprevention intervention is low yield when it comes to health. On the other hand, even short term tobacco cessation is a good thing. When it comes to the ability of wellness to reduce health care costs, weight reduction is unlikely to drive claims expense for a health insurer within two to three years, the impact of obesity on overall mortality rates is not as large as you’d think and “prevention” rarely saves money.

What’s more, these programs were able to achieve their “modest” outcomes without increasing claims expense.  Participants lost weight and stopped smoking at no additional cost to the system.  Now that is something.

Mrs. Smith and Reuters are very similar.  Both are struggling with nrealistic expectations thanks to dubious fashion trends, media misinformation and scientific ignorance.  Fortunately, Mrs. Smith had access to a resource that could help her better manage her weight.  The DMCB can only hope that Reuters has access to a resource that can help it manage its lack of background knowledge.

Jaan Sidorov, MD
Jaan Sidorov MD is the Host of the Disease Management Care Blog where he shares his knowledge and insights about medical home, disease management, population-based health care and managed care. He is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He is primary care by training, managed care by experience and population-based care strategies by disposition. The contents of his blog reflect only his opinions and should not be interpreted to have anything to do with any current or past employers, clients, customers, friends, acquaintances or enemies, personal, professional, foreign or domestic.


  1. I don’t think the issue is whether active motivated participants can lose weight (and I would certainly agree with you there), but why every single vendor produces such poor results that they feel compelled to lie about their outcomes (20% of vendors) or simply not report them out of a sense of integrity or fear of getting caught and exposed, usually by me and now occasionally in a major media outlet (80% of vendors)


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