Diagnosis, discussion and direction key to ‘effective’ obesity care
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The “3D approach” — formally diagnosing patients with obesity, initiating weight discussions and offering guidance and direction — helps facilitate “effective obesity care,” researchers wrote.
According to a 2019 New England of Journal Medicine study, 48.9% of adults in the United States will have obesity by 2030. Outside the U.S., a speaker at the 2020 European Congress on Obesity annual meeting said global diabetes prevalence will reach 11.7% by 2045 and 13.3% by 2100 if the current obesity rate increases linearly.
Assim A. AlfaddaMD, of the Obesity Research Center and department of internal medicine at King Saud University in Saudi Arabia, and colleagues wrote in the European Journal of Internal Medicine that primary care clinicians “are uniquely positioned to engage in weight management discussions with [patients with obesity] and evidence indicates that [health care professional (HCP)]–patient engagement and obesity diagnosis can facilitate weight loss.”
In a previous survey of 14,502 people with obesity and 2,785 HCPs, 54% of the patients said they had conversations about weight with their HCP in the past 5 years, 36% were diagnosed with obesity, and 21% had scheduled a follow-up appointment to discuss their weight.
In a new analysis of the survey data, Alfadda and colleagues reviewed responses from 2,331 HCPs regarding attitudes and behaviors “to identify HCP-related factors that could significantly influence the quality of obesity care.” The HCPs were from Australia, North and South America, Europe and Asia, and had at least 10% of patients with a BMI indicating obesity or higher. The analysis excluded general, plastic and bariatric surgeons.
Alfadda and colleagues reported that HCPs were “significantly more likely” to start weight discussions (OR = 1.59; 95% CI, 1.43-1.76) and notify applicable patients of their obesity diagnosis (OR = 2.16; 95% CI, 1.94-2.4) if they registered the obesity diagnosis in their patients’ medical notes. HCPs were also more likely to start conversations about weight with their patients if they were “motivated” to help patients lose weight (OR = 1.36; 95% CI, 1.21-1.53) or help them understand the effect of obesity on overall health (OR = 1.3; 95% CI, 1.17-1.45).
The researchers also wrote that the “motivated” HCPs were more likely to schedule follow-up appointments (OR = 1.21; 95% CI, 1.06-1.38). Conversely, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (OR = 0.83; 95% CI, 0.74-0.92) or schedule follow-up appointments (OR = 0.69; 95% CI, 0.62-0.78).
“Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management,” Alfadda and colleagues wrote.
These actions could also help reduce the financial burden of obesity, they added.
Reference:
Caterson ID, et al. Diabetes Obesity Metab. 2019;doi:10.1111/dom.13752.
Perspective
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Fatima Cody Stanford, MD, MPH, MPA, MBA, MACP, FAAP, FAHA, FAMWA, FTOS
Some of the authors of this article are very active in diagnosing, treating and providing long-term care to patients with diabetes.
The 3D method Alfadda and colleagues describe — discussion, diagnosis and direction — are not too different from key developments in the United States in this clinical area. The differences are minimal: here in the U.S., discussions with the patients often come after the diagnosis of obesity has been made, but in the 3D model, these processes are reversed. Both U.S. methods and the one described by Alfadda and colleagues are based on the ACTION study, the first U.S. study that looked at barriers to obesity management for patients with the condition, health care professionals and employers.
A positive thing that I see from this study is that countries around the world are beginning to recognize the importance of diagnosing and treating patients with obesity and the need for continued sustained care of these patients. Obesity is the world's largest chronic disease, with countries such as the United Arab Emirates — the country one of the authors of this study calls home — having obesity rates that rival ours.
There are multiple resources out there to help physicians treat their patients with obesity. Among the most recent are ‘Weight can’t weight’ by the Stop Obesity Alliance and the ACP’s brief curriculum, the latter of which was recently updated and is specifically geared for primary care patients.
For more information:
ACP online learning center. Obesity. https://www.acponline.org/cme-moc/online-learning-center/obesity.
Weight can’t weight. https://stop.publichealth.gwu.edu/wcw.
Obesity medicine physician, internist and pediatrician, Massachusetts General Hospital and Harvard Medical School
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