Frequently asked questions
Get answers to common questions about obesity and learn how to be the best partner and advocate for your patients today
About obesity
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
Obesity is associated with over 60 comorbidities that affect multiple organ systems, according to the Obesity Medicine Association.6 Such comorbidities include depression, Obstructive Sleep Apnea (OSA), type 2 diabetes mellitus, asthma, dyslipidemia, gastroesophageal reflux disease (GERD), nonalcoholic fatty liver disease (NAFLD), female infertility, hypertension, diabetes risk, metabolic syndrome, prediabetes, cardiovascular disease, various cancers, osteoarthritis, polycystic ovary syndrome (PCOS), male hypogonadism, and urinary stress incontinence.7
Wondering what your patients’ risks are for obesity-related comorbidities?
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
Talking with your patients
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 to 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.
Support for people with obesity
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 in 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.
Access modules to test your knowledge
See how COVID-19 may impact people with obesity
References
1. WHO Consultation on Obesity. Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva, Switzerland: World Health Organization; 1999. WHO technical report series 894.
2. US Census Bureau. QuickFacts: United States. Accessed March 13, 2020. https://www.census.gov/quickfacts/fact/table/US#viewtop.
3. Facts about hypertension. Centers for Disease Control and Prevention website. Accessed March 1, 2021. http://www.cdc.gov/bloodpressure/facts.htm.
4. Adult obesity facts. Centers for Disease Control and Prevention website. Accessed March 1, 2021. http://www.cdc.gov/obesity/data/adult.html.
5. High cholesterol facts. Centers for Disease Control and Prevention website. Accessed March 13, 2020. https://www.cdc.gov/cholesterol/facts.htm.
6. Bays HE, McCarthy W, Christensen S, et al. Obesity Algorithm eBook. Presented by the Obesity Medicine Association. 2020. Accessed March 3, 2021. https://obesitymedicine.org/obesity-algorithm/.
7. Garvey WT, Mechanick Jl, Einhorn D. The American Association of Clinical Endocrinologists and the American College of Endocrinology: 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014;20(9):977-989.
8. Lam YY, Ravussin E. Analysis of energy metabolism in humans: a review of methodologies. Mol Metab. 2016;5(11):1057-1071.
9. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604.
10. Hebebrand J, Hinney A, Knoll N, Volckmar A-L, Scherag A. Molecular genetic aspects of weight regulation. Dtsch Arztebl Int. 2013;110(19):338-344.
11. Obesity and overweight. World Health Organization website. Accessed March 13, 2020. http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
12. Affenito SG, Franko DL, Striegel-Moore RH, Thompson D. Behavioral determinants of obesity: reseach findings and policy implications. J Obes. 2012;2012:1-4.
13. Bray GA, Kim KK, Wilding JPH. Obesity: a chronic relapsing progressive disease. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715-723.
14. Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analysis of 57 prospective studies. Lancet. 2009;373(9669):1083-1096.
15. Puhl R, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17(5):941-964.
16. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013;59(1):27-31.
17. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481-1486.
18. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187-194.
19. Coronavirus Disease 2019 (COVID-19): people with certain medical conditions. The Centers for Disease Control and Prevention website. Updated September 11, 2020. Accessed September 18, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.
20. COVID-19 laboratory-confirmed hospitalizations. The Centers for Disease Control and Prevention website. Accessed September 18, 2020. https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html.
21. Rottoli M, Bernante P, Belvedere A, et al. How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalised COVID-19 patients? Results from a single Italian centre. Eur J Endocrinol. 2020;183(4):389-397.
22. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area [published correction appears in JAMA. 2020 May 26;323(20):2098]. JAMA. 2020;323(20):2052-2059.
