Obesity is a chronic disease that impairs normal bodily function, has characteristic signs and symptoms, and is associated with harm or morbidity, including increased risk of mortality and a wide array of complications. Obesity-associated complications can manifest as physical effects resulting from increased fat mass or as pathological metabolic and physiologic consequences of fat tissue dysfunction and insulin resistance. Obesity can also contribute to psychological disorders, including depression and social stigmatization.

Given the dire health consequences, the increasing prevalence of adult obesity in the last two to three decades mandates that healthcare providers engage in weight management as a pathway to health improvement. Estimates based on US population data show that the proportion of individuals ≥ 18 years with obesity more than doubled from 1990 to 2008, and rates of severe obesity also increased significantly. The estimated annual US costs associated with obesity management are high and are only expected to increase if disease prevalence trends continue.

There have been calls to increase the awareness and availability of resources and tools, particularly weight loss medications, so that physicians and other healthcare professionals can provide comprehensive, individualized obesity treatment. This comprehensive approach to obesity management is crucial in navigating the challenges faced by individuals struggling with this chronic condition.

Key Takeaways

• Obesity is a chronic disease with numerous physical and psychological complications.
• The prevalence of adult obesity has more than doubled in the last two decades.
• Healthcare providers must engage in comprehensive weight management strategies to address this growing public health concern.
• Increased access to resources, including weight loss medications, is necessary for individualized obesity treatment.
• A multifaceted approach is crucial in navigating the challenges of obesity management.

Introduction to Obesity as a Chronic Disease

Adult obesity is recognized as a chronic disease, meeting the criteria that define a disease by impairing normal bodily function, having characteristic signs and symptoms, and being associated with harm or morbidity, including increased risk of mortality and a wide array of complications. The body mass index (bmi) has been used to define body weight categories and identify individuals with elevated weight-related health risks. Current guidelines confirm that BMI cut points for overweight (>25.0–29.9 kg/m2) and obesity (≥30 kg/m2) are reasonable indicators for screening individuals who may have elevated weight-related health risks.

Prevalence and Costs of Obesity

The prevalence of adult obesity in the US has more than doubled from 1990 to 2008, with the proportion of individuals ≥ 18 years with obesity increasing from 11.1% to 26.9% and rates of severe obesity increasing from 0.9% to 3.5%. The estimated annual US costs associated with obesity management are high, ranging from 9% to 21% of national health expenditures, and are expected to continue increasing with the rising disease prevalence.

Obesity-Related Complications and Risks

Obesity-associated complications can manifest as physical effects resulting from increased fat mass, such as osteoarthritis, obstructive sleep apnea, and urinary incontinence, or as pathological metabolic and physiologic consequences of fat tissue dysfunction and insulin resistance, including cancer, dyslipidemia, hepatosteatosis, hypertension, and type 2 diabetes. Obesity can also contribute to psychological disorders, including depression and social stigmatization.

Recognizing the Need for Weight Management

Given the dire health consequences, the increasing prevalence of adult obesity mandates that healthcare providers engage in weight management as a pathway to health improvement. This includes promoting healthy meal planning, encouraging dietary guidelines adherence, and addressing emotional eating and weight loss programs, as well as considering bariatric surgery for individuals with severe obesity.

COVID-19 and the Increased Risks of Obesity

Emerging evidence from the UK and around the world indicates that individuals who are overweight or living with obesity face an elevated risk of severe illness, hospitalization, and poor outcomes from COVID-19. These risks increase progressively as a person’s body mass index (BMI) rises. There are several reasons why those with obesity are more vulnerable to serious COVID-19 complications, including the detrimental effects of excess fat tissue on vital organs, heightened inflammation, and decreased immune response to the infection.

Impact of Obesity on COVID-19 Severity and Outcomes

People with obesity have a greater chance of requiring hospitalization, advanced treatments like mechanical ventilation, or admission to Intensive Care Units if they contract COVID-19. They also face a higher risk of dying from the virus compared to those without obesity. These concerning trends underscore the significant health consequences that obesity can have during a pandemic like COVID-19.

Obesity as a Modifiable Risk Factor for COVID-19

Excess weight is one of the few modifiable risk factors for severe COVID-19. By supporting individuals to achieve and maintain a healthier body mass index, we can help keep people fit and well as we navigate the challenges of this pandemic. Tackling the obesity epidemic could also ease the burden on healthcare systems by reducing obesity-related hospital admissions and allowing doctors and nurses to focus on treating other patients.

Reducing Pressure on Healthcare Systems

Lowering the prevalence of obesity would be a crucial step in relieving the immense pressure that COVID-19 has placed on healthcare systems worldwide. Fewer obesity-related hospitalizations and complications would free up valuable resources and time for medical professionals to provide care for all patients in need, ultimately improving overall community health outcomes.

A Call to Action: Empowering Healthier Choices

COVID-19 has given us a wake-up call, and we need to use this moment to kick start our health, get active, and eat better. Public Health England’s new Better Health campaign will urge people to take stock of how they live their lives in the wake of the COVID-19 pandemic, promoting evidence-based tools and apps with advice on how to lose weight and keep it off.

Public Health England’s Better Health Campaign

The campaign aims to reach millions of people who need to lose weight, encouraging them to make lifestyle changes to eat better and move more to prevent or delay the onset of serious diseases. This will be supported by a 12-week weight loss plan app that people who are living with obesity can use to develop healthier eating habits, get more active, and lose weight.

Expanding Weight Management Services

The government also plans to expand weight management services so that more people get the support they need to lose weight, ensuring these services are available for people living with obesity.

Weight Management and Obesity

An essential first step in treating obesity as a chronic disease is identifying individuals who may benefit from therapeutic intervention. Body mass index (BMI), an established measure of screening for obesity, has been used to define body weight categories and identify individuals with elevated weight-related health risks. Current guidelines confirm that BMI cut points for overweight (>25.0–29.9 kg/m2) and obesity (≥30 kg/m2) are reasonable indicators for screening individuals who may have elevated weight-related health risks.

Assessing Disease Severity and Treatment Goals

Once identified, the severity of the disease should be assessed, and appropriate treatment goals should be set in collaboration with the patient. A collaborative, patient-centered care approach is emphasized, where the patient and care provider work together to determine the best individualized therapeutic strategies that address overweight and obesity, considering the patient’s disease status, needs, preferences, and attitudes regarding treatment.

Collaborative, Patient-Centered Care Approach

A collaborative, patient-centered care approach is essential, where the patient and care provider work together to determine the best individualized therapeutic strategies that address overweight and obesity, considering the patient’s disease status, needs, preferences, and attitudes regarding treatment.

Advances in Lifestyle Interventions

Recent advancements in interventions for lifestyle management have provided clinicians with a wealth of options to help their adult patients with obesity reduce morbidity and improve their quality of life. An array of resources and tools have become available to support individuals in their weight loss efforts, including a diverse range of diet options, activity monitors, social networks, and structured weight loss programs.

Diet and Activity Tracking Tools

Diet and activity tracking tools can be invaluable in empowering individuals to monitor their calorie intake and physical activity levels. By providing real-time feedback and insights, these digital tools can help users make more informed decisions, leading to sustainable weight management through diet tracking and activity tracking.

Structured Weight Loss Programs

In addition to personal tracking tools, structured weight loss programs offer comprehensive, evidence-based strategies for individuals seeking to achieve and maintain a healthy weight. These programs often incorporate behavior modification techniques, nutrition education, and tailored exercise plans to support long-term lifestyle changes.

Social Support Networks

The value of social support cannot be overstated in the context of weight management. Both in-person and online social support networks can be instrumental in helping individuals stay motivated, accountable, and connected throughout their weight loss journey, ultimately enhancing their chances of success.

Pharmacotherapies for Obesity Management

The number of pharmacotherapeutic options for the treatment of obesity has increased, providing healthcare professionals with more tools to offer individualized care for patients. Currently, five distinct medications have been approved for long-term weight management in the United States, including the lipase inhibitor orlistat, a fixed-dose combination of phentermine and topiramate, the serotonin 2c receptor agonist lorcaserin, a fixed-dose combination of naltrexone and bupropion, and the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide at a 3.0-mg dose.

Current Approved Medications

These obesity medications provide healthcare professionals with a range of options to address the specific needs and preferences of their patients struggling with obesity. By offering a variety of pharmacotherapies, clinicians can tailor their treatment approaches to help individuals achieve and maintain healthy weights.

Emerging Therapies and Combinations

In addition to the currently approved obesity medications, there are also emerging therapies and combination products in development that may further expand the pharmacotherapeutic landscape for obesity management in the future. As the field of obesity treatment continues to evolve, healthcare providers can stay informed about these emerging options to provide their patients with the most up-to-date and comprehensive care.

Applying Treatment Recommendations

To illustrate the application of current treatment recommendations and therapeutic interventions for obesity management, two clinically relevant case studies are presented. The first case study examines the approach for an individual who is overweight with accompanying comorbidities, such as hypertension and type 2 diabetes. The second case study explores the considerations for an individual with severe obesity but without any weight-related complications.

Case Study: Overweight with Comorbidities

John, a 52-year-old male, presents with a body mass index (BMI) of 27.8 kg/m², categorizing him as overweight. During the initial assessment, it is revealed that he also suffers from hypertension and type 2 diabetes, both of which are well-controlled with medication. John expresses a strong desire to improve his overall health and reduce his risk of further complications.

In a collaborative, patient-centered approach, John and his healthcare provider discuss the treatment options best suited to his specific needs and preferences. Together, they decide to implement a comprehensive lifestyle intervention program that includes a balanced, calorie-controlled diet, regular physical activity, and behavioral counseling to address both his overweight status and comorbid conditions.

Through regular monitoring and follow-up visits, John’s progress is closely tracked. Over the course of six months, he successfully loses 12 pounds, bringing his BMI down to 26.1 kg/m². Importantly, his blood pressure and blood glucose levels have also improved, reducing his risk of cardiovascular events and further disease progression. John reports feeling more energetic and confident, and he is committed to maintaining these positive lifestyle changes long-term.

Case Study: Severe Obesity without Complications

Sarah, a 38-year-old female, presents with a BMI of 42.3 kg/m², indicating she has severe obesity. Notably, Sarah does not have any weight-related comorbidities, such as hypertension, type 2 diabetes, or cardiovascular disease. However, she expresses concerns about the potential long-term health risks associated with her weight and her desire to improve her overall well-being.

In their collaborative discussion, Sarah and her healthcare provider thoroughly review the treatment options available, weighing the potential benefits and risks of each approach. Given Sarah’s severe obesity without any immediate complications, they agree to start with an intensive lifestyle intervention program that combines a structured, evidence-based weight loss plan with regular physical activity and behavioral therapy.

Over the course of 12 months, Sarah diligently follows the prescribed lifestyle program, making significant progress. She loses 35 pounds, reducing her BMI to 37.8 kg/m². Her weight loss has positively impacted her overall physical and mental well-being, and she reports feeling more confident and motivated to continue her healthy habits. Although Sarah’s weight is still in the severe obesity range, her healthcare provider is pleased with the improvements made and the potential to further reduce her long-term health risks through ongoing support and treatment.

These case studies highlight the importance of a collaborative, patient-centered care approach, where the healthcare provider works closely with the patient to determine the appropriate therapeutic strategies based on the individual’s disease status, needs, preferences, and attitudes regarding treatment. By addressing the unique circumstances of each patient, healthcare providers can optimize obesity management and empower individuals to achieve sustainable, long-term improvements in their health and well-being.

Overcoming Barriers and Challenges

Despite the availability of evidence-based lifestyle interventions and pharmacotherapies for obesity management, various barriers and challenges can impede successful weight loss and long-term weight management. Healthcare providers need to be aware of and address these obstacles, which include the social stigma and misconceptions surrounding obesity, limited access to comprehensive weight management resources and services, and the difficulty of promoting long-term adherence to lifestyle changes and treatment regimens.

Addressing Stigma and Misconceptions

The pervasive social stigma associated with obesity can have detrimental effects on individuals’ mental health and well-being, often discouraging them from seeking the support they need. Healthcare providers must play a vital role in addressing these misconceptions and fostering a more compassionate, understanding environment for individuals affected by this chronic disease.

Improving Access to Resources

Limited access to resources and comprehensive weight management services remains a significant barrier, particularly for underserved communities. Expanding the availability and affordability of evidence-based programs, dietary counseling, physical activity support, and pharmacotherapies will be crucial in empowering individuals to take control of their health.

Promoting Long-Term Adherence

Maintaining long-term adherence to lifestyle changes and treatment regimens can be a significant challenge for individuals with obesity. Healthcare providers must work closely with patients to develop personalized strategies that address their unique needs, preferences, and barriers, ensuring they have the tools and support necessary to achieve sustainable weight loss and manage their condition effectively over time.

Addressing these barriers through education, increased resource availability, and patient-centered support strategies will be crucial in empowering individuals to achieve and maintain healthy weights.

The Future of Obesity Management

The future of obesity management holds promise, with the development of new technologies and innovative approaches to enhance weight loss and weight management efforts. Emerging technologies, such as advanced digital health tools, wearable devices, and telemedicine applications, can provide individuals with greater access to personalized support, real-time feedback, and tailored interventions to promote behavior change and weight loss.

Additionally, the integration of comprehensive obesity care into mainstream healthcare systems, including primary care, will be crucial to ensuring that individuals with obesity have access to the resources, support, and multidisciplinary expertise needed to effectively manage their condition. As the healthcare community continues to evolve its approach to obesity, these emerging technologies and healthcare system integration efforts will be key in improving outcomes and quality of life for individuals affected by this chronic disease.

Conclusion

In conclusion, obesity is a chronic disease that requires a comprehensive, multifaceted approach to management. As a healthcare provider, I play a critical role in identifying individuals who may benefit from weight loss interventions, assessing disease severity, and collaborating with patients to establish appropriate treatment goals and strategies. The recent advancements in lifestyle interventions, such as digital health tools and structured weight loss programs, as well as the expanding pharmacotherapeutic landscape, have provided me with more options to offer personalized, evidence-based care to my patients.

However, overcoming the various barriers and challenges associated with obesity management, including stigma, access to resources, and long-term adherence, will be essential to empowering individuals and improving outcomes. As the healthcare community continues to evolve its approach to obesity management, integrating innovative technologies and comprehensive care into mainstream systems will be key in addressing this growing public health concern.

By staying up-to-date with the latest advancements, fostering a collaborative, patient-centered approach, and addressing the barriers to successful weight management, I can play a pivotal role in helping my patients achieve and maintain healthier weights, ultimately improving their overall health and well-being.

Source Links

• https://www.gov.uk/government/publications/tackling-obesity-government-strategy/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824226/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699189/