The fifth Salus Health Care Forum was held on August 7, 2024. In attendance were Mitch Applegate, William Bergquist, Jeremy Fish, Perry Pugno, Scott Sandland and Mark Vukalcic. The Trigger topic for this forum was provided by Bill Gillanders who introduced some of the challenges associated with treatment and prevention of obesity.

Following is a written documentation of the Forum dialogue:

Jeremy: Bill Gillanders has provided the trigger topic. It concerns the challenges of treating obesity.

Bill G. I’ll start with some trigger questions that I assumed will get us into some systems thinking.  Several sessions ago (of the forum) we noted that there is a variety of research indicating that we should be personalizing the diagnosis of obesity. Not just using the BMI screener. However, from what I have read over the past several months, BMI still works very well as a population screen; however, it is more sensitive than we would like it to be. Many people don’t necessarily meet the criteria of obesity from a medical perspective. There are a couple of questions to put out there. A recent multi-disciplinary commission is trying to define obesity as a disease, not just a condition that is associated with putting people at risk for other diseases. It is a chronic disease in and of itself.  This has a lot to do with looking at the underlying metabolic effects of obesity itself—not just its effect on the risk of activating other illnesses.

The other issue we might address has to do with systems and how we care about obesity. The value of Novartis stock has reached 500 billion dollars. This more than the GDP of Denmark. This remarkable, since Novartis is housed in Denmark. The headlines read: Novartis has become more valuable than Denmark.

The projection is that with the increase in obesity – particularly in the Unted States – possibly 40% of the US pop0ulaton wit have BMIs great than 35 by 2030.  This is pretty amazing. I offer a personal reflection. We were over in Europe earlier this summer. We went to Italy, France, Germany, the Netherlands and Switzerland.  It is remarkable how many fewer obese people you see walking around in Europe than the US. It’s not zero by any means in Europe, but obesity is certainly much less prevalent among our European colleagues. I don’t think it is genetics.

Bill B: So Bill [G], what do you think are some of the reasons why folks are thinner in Europe then they are here.  Well certainly people seem to be more physically active in all of the countries I visited.  There is a lot more walking.  And in many of the cities, bicycles are a primary means of transportation. It has been pointed out that in most major cities a trip of under 2 miles is much more amenable to bicycles than an automobile. It is much more efficient that an automobile, or even a streetcar or bus. The other thing is that I do think people have a sense that it is not “cool” to be heavy—this is particularly the case among young people in Europe. There aren’t a lot of these plus sizes or “embrace your big person.” There is clearly a cultural issue. And it may be that diets are better. I went to many great restaurants in Italy and France.  And Amsterdam (which had great restaurants). People go out to eat quite a bit. It’s not that there aren’t rich, confectionary foods around, but it seems that people are just not driven as much as we are to consume as much as we are.