MANAGED CARE March 2000. ©2000 MediMedia USA
There's a charming little children's book called Pierre , written by Maurice Sendak in 1962. In the story, pint-sized Pierre could say nothing but "I don't care" whenever his parents spoke to him. When a hungry lion threatened to eat Pierre, the crumb crusher's comeback was "I don't care." Pierre became the lion's dinner. The moral of this story? Care!
A similar tale could be written about obesity. Obesity is a ticking time bomb, in terms of both health and health care expense. But the reaction of the public and of the health care community has been just like that of Pierre: "I don't care."
Physicians complain that once patients leave the doctor's office, all the advice is cast aside in favor of a comforting late-night bowl of ice cream. Plenty of evidence supports that, but there's equally embarrassing proof that physicians aren't expressing the message effectively or to enough patients.
Health plans, too, are culpable. Losing weight is more than a matter of will power; obesity is a complex, chronic condition, and fighting it effectively requires psychological support and skill training. It's a touchy-feely side of medicine whose benefits are hard to quantify, so few plans are willing to invest in it.
No question, this is bigger than any health plan. It's a public health issue — and as such, it is American health care's biggest failure. But the public finger-pointing among the principals in health care has distracted them from the objective: Reduce the incidence of obesity, a leading cause of premature death.
Mike Dalzell's cover story  explores how — and why — health plans can and should take the initiative on this, in conjunction with physicians and public health. Without that collaboration, the market will find its own way. The extreme scenario: Frustrated with the cost caring for "train wrecks waiting to happen," employers could divorce themselves from the benefit process and move toward a defined-contribution system.
We have beaten some of the most dreaded illnesses in history. If everyone would just care, we could beat obesity, too.