I admit that I am pretty cynical about medicine, as I think it is mostly interested in making money by billing people. And pharma is interested in making that as easy as possible. So, the goal becomes how to write a prescription that cost lots of money and give that to a person as rapidly as possible.

With inpatient treatment of major illness, this has typically not been the case, but with the migration of care from inpatient to outpatient we have settled into a model of healthcare that actually provides very little benefit for more serious illness.

Sure, outpatient treatment is great for an ear infection or to get a vaccine, but for anything more complicated (such as treating obesity) it is simply inadequate. As an example, even in terms of healthy eating, doctors, medicine, and the system want to reduce that to a simple prescription. In reality, implementing lifestyle change takes enormous changes in terms of:

• food one eats (amount, type, whole/processed, balance, timing)
• food one buys
• how one stores food (access)
• eating out
• eating with friends
• special occasions, travel, holiday eating
• what to drink
• how to deal with hunger
• how to deal with cravings
• changing the environment that one lives in
• enhancing the supports one has.
• adding or enhancing an exercise or activity strategy.
• eliminating excessive inactivity
• decreasing anxiety
• getting consistent and quality sleep

The list probably goes on longer and longer. We do a disservice to imply to folks that losing weight can be accomplished by a prescription for a drug or for simply buying better food. The likely failure leads to frustration and probably self-blame (“They said this would work! – it must be me”). Let’s explain to folks that losing weight is hard, like getting to the Moon (per President Kennedy). But that we think we can accomplish this goal, and we can get it done if we outline a clear strategy.

I am all about personalized medicine. In addition to considering all of the relevant factors, we need to spend more time understanding the person who is obese (including genetic tests) and then defining a solution specifically for them. In today’s outpatient treatment, providers act like they consider the individual, but the reality is that providers follow “protocols” (not necessarily science-based or best practice) that basically do the same thing for everyone who has a similar problem. Efficient and quick is the key.

How do we deliver a personalized and clear strategy that includes all the above elements? Perhaps with a powerful and intelligent behavior change plan prescribed by a physician and followed by both the patient and physician. There is much potential in the digital therapeutic market, integrating with smart home technology. We just have to come up with a working solution that will be utilized by the majority of the population.