Providers, the community, health systems, and health policies can all play a part in addressing various challenges in care for obesity.
Research into the underlying causes and treatment of obesity as well as clinical care must continue to evolve to meet the needs of patients with obesity, according to a new scientific statement by the American Heart Association. The authors said that in order to bridge the gap in scientific implementation, providers, the community, health systems, and health policies can all play a part in addressing various challenges in care and to best optimize the data and science developing for obesity.1
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“Obesity is undeniably a critical public health concern in the [United States] and around the world, affecting nearly all populations and straining our health care systems,” Deepika Laddu, PhD, FAHA, chair of the statement writing committee and a senior research scientist at Arbor Research Collaborative for Health in Ann Arbor, Michigan, said in a press release. “As a major risk factor for heart disease, obesity has significantly hindered progress in reducing heart disease rates. Despite advancements in understanding the complexities of obesity and newer treatment options, major gaps remain between obesity research and real-world implementation in clinical practice.”2
In the statement, the authors described strategies that can be used for the clinical application of obesity-based research, identify gaps in clinical practice, and provide guidance and resources for health care professionals, community members, and other stakeholders for population-level management of obesity.1
The authors acknowledged that better education on obesity for health care providers is needed, stating that only 25% of the 24 general certification content outlines mentioned obesity. One education program the authors listed included the certification program in obesity medicine by the American Board of Obesity Medicine. They added that a framework for the successful delivery of obesity medicine care is essential, such as the evidence-based model from the Society for Behavioral Medicine. The model includes the “5As”: assess, advise, agree, assist, and arrange, which have been included by the AHA as ways to implement behavior change in primary and community-based settings for cardiovascular disease (CVD) prevention and risk management.1
Furthermore, the authors said that approximately 16% of health care providers could identify evidence-based lifestyle treatments for obesity, including low rates of working knowledge about diet and nutrition specialists, intensive behavioral therapy, and physical activity. They said this gap could explain the low rates of referral for these services. One way to implement lifestyle interventions would be to increase 2-way communication between the health care provider and the patient, so the patient feels comfortable in talking about their weight with their physician. The authors noted that physicians should adopt effective and sensitive ways to initiate talking about weight, but patients should also feel able to ask their physician questions in a safe environment.1
Pharmacotherapy for obesity has also shown effectiveness in real-world settings, with the most recent FDA approvals including semaglutide and tirzepatide. The authors note that obesity medications are underprescribed, and they identified the likely reasons for underutilizing these therapies, which included knowledge gaps, concerns about safety, and coverage limitations. They noted that the recent approval of semaglutide to reduce the risk of cardiovascular death, heart attack, and stroke for patients with CVD and either obesity or overweight has potential steer the conversation of obesity medication as a way to manage medical complications opposed to weight management.1
The authors also discussed metabolic and bariatric surgery, which they stated is a last-line therapy for severe obesity. The surgery was first introduced in the 1950s but has since become safer and more effective, and has lower risks for CVD incidents, adverse pregnancy outcomes, and other obesity-associated conditions. Further, the authors said that among patients with preexisting type 2 diabetes or CVD, patients also experienced improvements in glycemic parameters and cardiac structure and function.1
However, the authors said that a challenge in surgery for patients is access, which should be addressed, especially since the disparities are well established for severe obesity. For example, adolescents and adults who identify as Black or Hispanic/Latinx and those who have fewer social economic resources are less likely to undergo surgery, and the social perception of surgery for obesity is also a barrier to access, the authors said.1
The study authors also provided existing and emerging opportunities to address the gaps in clinical practice, including increasing physician training and facilitating referrals to obesity medicine specialists. Additionally, physicians need to be more comfortable and sensitive to weight-management discussions, which can be improved with training, referrals, and by engaging community health workers for diverse populations who are underrepresented in care. As for coverage, the authors stated that increasing reimbursement for all obesity management options and increasing support for patient access is essential to address gaps in care.1
The authors also emphasized the importance of addressing the stigma surrounding obesity, which they said could be done with sensitivity training, utilizing telemedicine to improve adherence, and to establish their clinics as a safe space for patients.1
Furthermore, the authors said that connecting patients with recommendations within the community and utilizing technology as tools for information can help access for patients. To address cost effectiveness, they added that engaging stakeholders, the community, and health professionals in conversations to improved cost-effectiveness programs is essential.1
Finally, they stated that improving social and community support by providing treatment approaches focused on couples, family, and household, and offering connections to community groups that provide resources and support to patients, can also address these gaps in clinical care.1
“While significant strides have been made in advancing the science to help us understand obesity, there remains a considerable gap between what we know and what happens in the doctor’s office,” said Laddu in the press release. “Health care professionals and health care systems need to find better ways to put what we know about obesity into action so more people can get the right support and treatment. Adopting new technologies and telemedicine, making referrals to community-based weight management programs to encourage behavioral change, providing social support and increasing reach and access to treatments are just some of the promising methods we could implement to unlock successful, evidence-based obesity care.”2
