Flea's daddy taught him a long time ago: if folks are doing stuff that doesn't make sense to you, follow the money and it'll all make sense.

Flea has negotiated managed care contracts with several HMOs that require him to manage obesity as a disease. We are required to track body-mass index (BMI) for every child starting at age 2. For children with BMI's above a certain level, we are required to make some kind of intervention. If we don't, the payors withhold money from us.

The payors themselves take cues from the U.S. Department of Health and Human Services.

The problem with managing obesity as a disease is three-fold. First, we lack reliable methods to screen children for obesity risk-factors later in life. Second, even if we did have reliable screening tools, we lack evidence-based medicine to guide us in managing obesity. Finally, there are significant potential harms that can be done to patients by telling them they're too fat.

So why are the HHS and the HMOs asking us to do something that makes no sense?

Follow the money.

That's what Sandy Szwarc did at Junkfood Science. Sandy asked how come such a great effort is being exerted on behalf of the obesity problem when we have no idea how to proceed? She discovered that the energy driving most obesity initiatives is the same thing that greases the wheels of the capitalist machine.

[M]ore than $800 million was funding these initiatives, most of which focused on increasing physical activity and improving diets, directed at 4.6 million children each year. Eight out of ten programs specifically targeted kids over 6 years of age and 20% were aimed at infants, toddlers and pre-schoolers. Fat children were targeted in 2/3 of the programs and the largest segment of participants were low-income. While the programs appear altruistic, two-thirds admitted their programs were created to support their marketing and corporate branding, and 100% were developing products and services using the child obesity issue. The largest motivating factor (admitted by 20% of the organizations) for initiating their programs was 'increasing public perception of a health care crisis.' (emphasis added)"

Flea will acknowledge that obesity is a (you'll pardon the expression) a big problem. But no problem was ever solved through an initiative that enjoins us to do anything for the sake of doing something.

For the record, Flea's got no problem with making money. He'd like to make lots and lots of it. We draw the line at being told how to practice medicine without evidence-basis, for the sole purpose that someone else can make a buck.