Obesity has long been a public health problem in the United States that providers have struggled to address, but medical experts say the latest research suggests doctors need to adopt a new "multipronged strategy" to help patients lose weight, Laura Landro reports for the Wall Street Journal.
Obesity in the US
The U.S. obesity rate has risen steadily over the past two decades, with the latest data showing 42.4% of adults ages 20 and older were obese in 2018, and 9.2% were severely obese. According to Landro, providers have long struggled with helping patients lose weight, often relying on diet and exercise—and treating poor results "as a failure on the part of patients."
But some medical experts say the Covid-19 epidemic's impact on patients with chronic conditions has put a spotlight back on obesity—and a new wave of research that shows it takes a combination of strategies to combat the condition.
'Promising' strategies for weight-loss
Recent studies have given medical experts more insight into how obesity affects the body and one's ability to lose weight, Landro reports.
Rekha Kumar, an endocrinologist at the Weill Cornell Medicine Comprehensive Weight Control Center, said, "Nobody is denying that there is behavioral component to obesity, but it is shortsighted and dangerous to fully blame an individual's behavior when there is so much evidence that the human body does not function normally in the condition of obesity."
That's why many medical experts are calling for providers to shift away from focusing strictly on behaviors like diet and exercise, and adopting a multipronged approach. Landro outlines three developments gaining attention "that hold promise."
1. Relying on obesity-medicine specialists
Most doctors have not received specialized training on obesity, which has proven to be a "longstanding obstacle to a more-comprehensive treatment" of the condition, Landro writes.
Doctors who lack specialized training on the topic might focus too much on diet and exercise, rather than other factors like genetics, psychological and environmental factors, or the body's natural response to a decrease in calories.
Obesity-medicine specialists on the other hand are trained to consider how biological, psychological, environmental, and genetic factors play a part in a patients' ability to lose weight.
Doctors with specialized training also know how to prescribe other strategies, like medication or weight-loss surgeries. Caroline Andrew, an obesity specialist at the Hospital for Special Surgery in New York who often treats patients waiting for a joint replacement procedure, relies on a variety of services to help her patients lose weight, including weight-loss drugs or referring patients to a dietician or behavioral health counselor.
2. Educating general practitioners
The American Board of Obesity Medicine has certified more than 4,000 obesity specialists in the United States and Canada, but that is still not enough obesity specialists to treat all patients, Landro reports.
That's why Louis Aronne, director of Weill Cornell's weight-control center, says "the average doctor" needs to be better trained to speak with and treat patients who have obesity. Weill Cornell's training program includes sensitivity training for doctors who treat obese patients and how to approach conversations around diet and exercise.
For instance, instead of mandating a specific food regimen, doctors, Landro writes, should consider patients' food preferences as well as diets they've tried in the past and devise a weight-loss program that meets their unique needs. It also teaches "office staff to be careful with language, such as 'a patient who has obesity' instead of 'obese patient' to avoid labeling patients by their disease," Landro writes.
Sadaf Mustafa, an internal-medicine doctor at MedStar Health and assistant professor at Georgetown University School of Medicine who became certified in obesity medicine two years ago, said the training helped her understand how medications for other common conditions, like depression and diabetes, can cause weight gain in patients.
"The impact of changing from one medication group to another can give them a huge benefit," she said. "That was a big eye-opener for me."
3. Incorporating medications and surgery into care
While weight-loss drugs and surgeries can be highly effective for some patients, doctors often only prescribe them as a last resort, Landro writes.
But the resistance to these methods is changing, especially now that research shows some surgeries are effective on a larger range of patients than doctors previously projected—and the latest procedures and medications have proven to be safer than older options, Landro reports.
According to Landro, some of the barriers that once prevented physicians from relying on medications and surgeries are being removed as more insurers are broadening their coverage requirements for weight-loss.
Gayle Novak said a combination of the weight-loss drug Qsymia and a specialized diet plan helped her lose weight that was causing health issues, like high blood pressure. Novak said the doctor "really took the time to know me, know my history, know my medical issues and understand what does and doesn't work for me" (Landro, Wall Street Journal, 6/8).