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Treating Obesity in Primary Care: Lifting the Veil of Invisibility

Author: Elizabeth Ciemins, Ph.D., M.P.H., M.A.

The prevalence of obesity among U.S. adults more than doubled from less than 15% in 1985 to 34% in 2005-2008. In 2017-2018, that prevalence skyrocketed to 42.4%! This staggering progression imitates the surge one might expect from a global pandemic. These rates, accompanied with the serious complications associated with obesity (e.g., diabetes, cardiovascular disease, chronic obstructive pulmonary disease) are a clear indicator that obesity is a disease that desperately needs to be identified and addressed. The COVID-19 pandemic has underscored the urgency of this need, as patients with chronic conditions like obesity and diabetes have been hospitalized, put on ventilators, and died at disproportionately high rates. In addition to the impact on patient health, obesity is expensive, with direct and indirect costs for treating it reaching nearly $2 trillion in 2016.

When it comes to obesity care delivery reform, the time to act is now. However, persistent challenges stand in the way. A recent commentary in the journal Obesity, “Obesity is Visible to Stigmatize but Invisible to Treat Despite Documentation in the Electronic Health Record,”identifies many of these challenges, such as clinicians not fully grasping the complexities of obesity, society continuing to stigmatize obesity and blaming it on patient behaviors, and a failure to provide medical and surgical treatments for obesity at a sufficient rate, despite the widespread availability of both. In fact, only 1-2% of patients with obesity receive medical or surgical treatment. This commentary accompanied a recent study by the American Medical Group Association (AMGA), which found an association between an obesity diagnosis and weight loss and rightly pointed out that there is much more work to be done (Fig. 1).

Fig. 1 Weight loss by obesity diagnosis on same day as initial weight. Compares weight loss of ≥ 5% and ≥ 10% body weight among individuals with and without an obesity diagnosis on a claim or patient problem list on the same day as an initial weight.

Primary care providers need help overcoming these challenges, and there are several new resources available. First, the STOP Obesity Alliance created a guide for the management of obesity, called Weight Can’t Wait, to assist primary care clinicians and teams in every step of the process, from pre-encounter through post-encounter. Second, AMGA created an Obesity Care Model Playbook that provides numerous examples of strategies AMGA-member healthcare organizations have tested and found successful, along with guides for how to implement these strategies. Specific examples from these healthcare organizations can be found in the AMGA Obesity Collaborative Case Studies from 10 AMGA-member organizations that participated in AMGA’s Obesity Care Model Collaborative, a multi-year initiative to improve the quality of care delivered to patients with obesity. Finally, a research article in Population Health Management, “Measuring What Matters: Beyond Quality Performance Measures in Caring for Adults with Obesity,” emphasizes the importance of measurement and tracking progress when implementing a primary care-based obesity program, not just for external reporting of quality performance measures, but for internal quality improvement processes.

It’s time to remove the invisibility cloak that keeps people with obesity from getting proper treatment from their healthcare professionals. While a formal diagnosis is a necessary condition on the road to reform, diagnosis alone is not sufficient to ensure patients with obesity receive the help and treatment they need. The resources exist to help healthcare professionals identify and address this disease. Clinicians cannot continue to look the other way or throw their hands up in frustration, and they have a duty not only to improve the care of patients with obesity, but also to reduce the societal stigma surrounding medical conditions, especially when they are beyond the control of those who have them. Obesity is a disease. Time to see it, and time to treat it.

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