Frequently asked questions

Yes, obesity is a chronic disease that is defined by the World Health Organization (WHO) as abnormal or excessive fat accumulation that may impair health.¹

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have published practice guidelines for treating patients with obesity.

Obesity is one of the most prevalent diseases in the US, affecting ~108 million adults. By comparison, there are 78 million adults in the US who could benefit from cholesterol medicine, and about 108 million adults in the US have high blood pressure.^1-5

The main contributing factors of obesity can be broken into 3 categories: societal, environmental, and genetic.^8-11

Examples of societal and environmental factors of obesity include changes in food production and availability, decreases in energy expenditure due to more sedentary lifestyles, socioeconomic status, cultural influences, and societal changes such as overeating and reduced physical activity.^11,12

Genetic factors of obesity may determine the extent to which these societal and environmental factors will impact a patient’s weight.¹⁰

Weight loss from reduced-caloric intake triggers a physiological process called metabolic adaptation. Weight loss causes the body to react by slowing the metabolism and altering appetite-regulating hormones, which can make long-term weight-management difficult.^8,9

Yes, increased BMI results in higher risk of mortality; in fact, for every 5 kg/m² BMI increment above the range of 22.5-25 kg/m², there is a 30% increase in overall mortality.^13,14

Patients with obesity can face a multitude of challenges, both socially and psychologically, including self-esteem issues as well as weight biases in both social and workplace situations.¹⁵

You may want to consider pharmacological treatments for your patients with overweight or obesity who⁷:

• Have tried lifestyle changes but can’t reach a healthier weight
• Are having difficulty with weight management
• Have a BMI of ≥27 kg/m² and a weight-related comorbidity
• Have a BMI that is >30 kg/m²

We recommend the 5As model, a behavioral intervention strategy that has been modified for obesity management. It helps increase patient motivation and behavior change in weight-management consultations.¹⁶

ASK for permission to discuss weight

ASSESS obesity class and stage

ADVISE on obesity risks

AGREE on realistic weight-loss expectations

ASSIST by providing education, resources, and support

Having a conversation focused on weight history can serve as a helpful complement to a full clinical and physical assessment before starting a weight-management plan. Some topics to consider when beginning a weight history discussion include:

• Changes in weight over time

• Factors in weight changes

• Descriptions of past weight-management efforts

• Current habits

While many of your patients may have greater weight-loss goals, a study showed that a modest weight loss of 5% or more can have a clinically meaningful impact.¹⁷

In the study, weight loss of 5% was associated with improvement in cardiovascular risk factors such as glycemic control, blood pressure, HDL cholesterol, and triglycerides.¹⁷

Studies also show that higher levels of weight loss can be associated with greater improvements in some comorbidities. Be sure to emphasize the difference that a weight loss of 5% or more can make in reducing the risk of comorbid conditions.^17,18

It's important to set long-term goals for patients and then create a plan to help them achieve them. We recommend setting SMART goals, which are:

SPECIFIC: Guide patients to set specific goals for changes to behavior or habits

Example: What are some healthy eating habits or activities that you feel you can start?

MEASURABLE: Ask how they will measure their progress toward achieving their goals

Example: What is the best way for you to track your new habits?

ACHIEVABLE: Discuss how confident they feel about achieving their goals to ensure that they are realistic

Example: On a scale of 1 to 10, how confident are you that you can achieve this goal?

RELEVANT: Ask about how their initial goals are relevant to their big-picture goals

Example: Why is this behavioral goal relevant or important to your overall plan?

TIMELY: Place a relatively short time frame on the initial goals to see if they are achievable in that period

Example: When will you begin?

The Obesity Treatment Modules Educational Series provides practical tools designed for HCPs and their office staff who want to learn how to provide quality care for their patients with obesity. In this series, Dr. Robert Kushner and Dr. Michael Kaplan will walk you through strategies and tips for diagnosing and discussing obesity with your patients, covering topics such as billing and coding documentation, motivational interviewing, goal setting, building a weight-management plan, and addressing weight plateau and weight regain.     

Obesity is a serious, chronic, and progressive disease that requires long-term management, but many people with obesity still lack the support they need to manage their weight.¹³ By partnering with your patients to develop comprehensive and individualized approaches to weight loss and weight management, you can make a huge impact on your patients’ lives and help fill the gaps in their health care that are keeping them from successful weight loss.

You can contact the Obesity Care Advocacy Network (OCAN) to advocate for individual patients, reach out to legislators, understand current policy, and more.

Obesity puts you at a higher risk of severe illness with COVID-19. Talk to your patients with obesity to help them get the weight-management care they need.¹⁹

Obesity in adolescence is on the rise, with a 3-fold increase in prevalence since the 70s.²⁰ Many of the weight-related conditions we see in the adult population, like hypertension, type 2 diabetes, and dyslipidemia, are now becoming more common in people younger than 18 years of age who have obesity. Because obesity is a chronic condition, ongoing monitoring and treatment are required, which may include intensive lifestyle modification, pharmacotherapy, or even surgical intervention.²¹

Your patients’ culture may be more important than you think when looking to help them with their obesity. Whether it’s cultural behaviors around food that can impact weight goals, differences in acceptance in body images, or a reluctance to seek medical help, you should try and consider cultural factors when determining weight-management goals in an open discussion with your patients.²²

Obesity is associated with at least 60 serious comorbidities that include obstructive sleep apnea (OSA), type 2 diabetes, prediabetes, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), female infertility, hypertension, osteoarthritis, polycystic ovary syndrome (PCOS), and many more.^6,7,18 Yet studies have shown that weight loss of as little as 5% can help improve many of those comorbidities.¹⁸