Asthma care often fails to include obesity management despite guidelines
Key takeaways:
- Guidelines say patients with obesity and asthma should lose between 5% and 10% of their weight.
- Primary care discussed obesity management more often than subspecialties.
SAN DIEGO — Among patients with asthma and obesity, about a quarter of encounters include obesity management, according to a poster at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
“There are few guidelines such as [Global Initiative for Asthma (GINA)] that recommend that obesity management or weight loss be discussed in the context of asthma,” Oluwatobi Olayiwola, MD, second-year fellow in the division of allergy and clinical immunology at Brigham and Women’s Hospital and research associate with the Immune Tolerance Network, told Healio.
GINA recommends that patients with obesity and asthma lose between 5% and 10% of their weight, Olayiwola noted.
“But there’s really not a lot of guidance on how to do it,” Olayiwola continued. “And then, we don’t also know whether provider practices reflect this recommendation. So, we wanted to know if it’s being done.”
Olayiwola and her colleagues used Open AI’s GPT-4o large language model to analyze 17,660 encounters with adults with asthma and obesity in a multi-hospital electronic health record between Jan. 1, 2020, and Sept. 30, 2023, including primary care (34.1%), allergy and immunology (17%) and pulmonology (48.9%).
The researchers asked the large language model if asthma was discussed during the encounter.
“That was just a validated question to make sure the inclusion criteria worked,” Olayiwola said.
If asthma was discussed, the researchers then asked if obesity management was discussed. If it was discussed, the researchers asked if it was being discussed in the context of asthma care as well as which strategies were being used.
“Unfortunately, of the 17,660 encounters, only about 25% had obesity management, and then when you look at that 25%, it’s about 50-50, whether providers linked weight loss to asthma,” Olayiwola said.
The large language model reported that 25.8% (n = 4,563) of encounters included obesity management, with 48.7% of these encounters including obesity management as part of the asthma plan.
Since the timeframe included the pandemic era, Olayiwola said that she and her colleagues wanted to see if there was a difference between in-person (72.9%) and virtual (27.1%) encounters, including video and telephone.
“No significant difference between in-person and virtual,” Olayiwola said.
However, differences emerged by specialty, she said.
Among primary care encounters for asthma, 74.3% did not include any obesity management, 21% included obesity but not as part of asthma care and 4.7% included obesity management as part of asthma care.
Similarly, 89.5% of allergy and immunology encounters for asthma did not include any obesity management, 3.6% included obesity but not as part of asthma care and 6.9% included obesity management as part of asthma care.
In the pulmonary encounters for asthma, 68.7% did not include obesity management, 11.2% included obesity but not as part of asthma care and 20.1% included obesity management as part of asthma care.
“Primary care providers are doing a lot of obesity management,” she said. “But they’re not linking it so much to asthma.”
Pulmonary medicine is “doing an excellent job,” she continued, with obesity management linked to asthma.
“Allergy and immunology providers, unfortunately, are not doing obesity management. But we do link it to asthma care when we do it. Yet, we do know that weight loss impacts your asthma symptoms and severity,” Olayiwola said.
There were differences in the strategies that providers recommended during these encounters (n = 2,224) as well, Olayiwola continued.
“Exercise is the No. 1 that all providers are recommending,” she said.
Overall, the most common strategies recommended during encounters included exercise (58.9%), general weight loss counseling (55.5%), diet (17.1%), weight loss programs (6%), bariatric care or weight loss surgery (4.9%) and weight loss medications (2.8%).
“Primary care tends to focus more on specific strategies, such as diet and specific weight loss programs,” Olayiwola said.
Percentages for primary care (n = 280) included 61.4% for exercise, 41.8% for general weight loss counseling, 28.9% for diet, 6.1% for weight loss medications, 5% for weight loss programs and 2.9% for bariatric care or weight loss surgery.
“Subspecialties are doing more referrals out,” Olayiwola said. “We’re saying, go see endocrine or bariatric surgery.”
Among the subspecialties (n = 1,944), percentages included 58.5% for exercise, 57.5% for general weight loss counseling, 15.4% for diet, 6.2% for weight loss programs, 5.2% for bariatric care or weight loss surgery and 2.3% for weight loss medications.
Olayiwola noted that the inclusion criteria required asthma to be the primary diagnosis of each encounter, which may have impacted the results.
“Truthfully, primary care providers are probably doing more than has been shown here as part of regular yearly maintenance,” she said. “Previous studies have shown that there are patient and provider factors that affect whether obesity management is discussed during an encounter.”
Olayiwola also attributed the lack of obesity management in these encounters to time constraints and provider discomfort.
“It is challenging to do a comprehensive counseling on weight loss in a short amount of time,” she said. “Also, some providers also don’t feel comfortable. Allergists don’t get trained extensively in metabolic diseases, weight loss, or weight loss strategies.”
Patient factors also matter, she added.
“There is still a lot of stigmas associated with obesity and having a medical conversation about weight loss,” Olayiwola said. “Some studies have also suggested that some patients are reluctant to receive those conversations. There are lots of other factors as well, such as health systems factors.”
Olayiwola hopes that these findings, noting that they are preliminary data, will encourage more obesity management in asthma care. She and her colleagues are now completing their final analyses and preparing a manuscript for publication.
“We want to publish this, to say, ‘Hey, we’re not doing obesity management in this high-risk population with comorbid obesity and asthma’” she said.
Future guidelines with more details on the benefits of weight loss in patients with obesity and asthma would help, she said.
“We all look at GINA guidelines for reference on the management of asthma,” she said. “But a more expansive section on obesity management in asthma would be a first step. Asthma providers would then have something to refer to.”
Next, Olayiwola and her colleagues plan on conducting a sensitivity analysis to identify patient features that could predict obesity management. They also aim to identify barriers in care and conduct intervention studies to support guidelines.
For more information:
Oluwatobi Olayiwola, MD, can be reached at oolayiwola1@bwh.harvard.edu.