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 ~100 million adults. By comparison, there are 78 million adults in the US with high cholesterol who are recommended medicine and about 75 million adults in the US have high blood pressure.^2-5

Obesity is associated with 57 comorbidities that affect multiple organ systems, according to the Obesity Medicine Association (OMA). Such comorbidities include migraines, cardiovascular disease, type 2 diabetes, gout, high blood pressure, and several types of cancer.^6,7

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.^1,8,9

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.^10,11

Genetic factors of obesity may determine the extent to which these societal and environmental factors will impact a patient’s weight.¹²

The body naturally has metabolic and hormonal responses to weight loss that hold patients back from losing weight and keeping it off, despite their best efforts.^8,9

Even with continued decreased caloric intake and increased physical activity, metabolic adaptation results in a decrease in resting metabolic rate and satiety hormones (amylin, insulin, leptin, GLP-1, PYY, and CCK) and an increase in the hunger hormone (ghrelin).^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 who⁷:

• Have tried lifestyle changes but can’t reach a healthier weight

• Are regaining weight after losing it

• 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.

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.¹⁶

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.¹⁶

When talking with your patients, be sure to emphasize the difference even a 5% weight loss can make in reducing the risk of comorbid conditions.¹⁶

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 for your patients, which are:

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

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

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

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

• 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. 

Obesity is a serious, progressive disease that requires long-term management, but many people with obesity still lack the support they need to manage their weight. 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.

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. https://www.census.gov/quickfacts/fact/table/US#viewtop. Accessed March 13, 2020.

3. Centers for Disease Control and Prevention. Obesity and overweight. http://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Last updated May 3, 2017. Accessed March 13, 2020.

4. High blood pressure fact sheet. Centers for Disease Control and Prevention website. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm. Accessed March 13, 2020.

5. High cholesterol facts. Centers for Disease Control and Prevention website. https://www.cdc.gov/cholesterol/facts.htm. Accessed March 13, 2020.

6. Bays HE, Seger JC, Primack C, et al. Obesity algorithm 2016-2017. Presented by the Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm. Accessed March 13, 2020.

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. Obesity and overweight. World Health Organization website. http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight. Accessed March 13, 2020.

11. Affenito SG, Franko DL, Striegel-Moore RH, Thompson D. Behavioral determinants of obesity: reseach findings and policy implications. J Obes. 2012;2012:1-4.

12. 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.

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. 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.