How Primary Care for Obesity is Changing

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Seven years have passed since the AMA resolved that obesity is a complex chronic disease that requires good medical management. Slowly in some ways, more quickly in others, we are seeing changes in primary care for obesity.

The standard of care is slowly rising. No longer is simply advising a patient to lose weight what good providers do.

Change in medical practices is slow, with 17 years being the benchmark for a major change. So even though this progress seems slow to advocates for people living with obesity, it’s on par with the timing we see for most advances in care.

What has changed

In the past decade,we have seen a lot of change for the better:

• Weight bias is more clearly understood to be an obstacle to improving the health of people with obesity.
• Explicit bias is no longer acceptable as it once was.
• Gastric bypass and sleeve surgeries are more common and their benefits are clearer – including remissions of type 2 diabetes.
• Newer and better drugs for treating obesity are now available and more are on the way.
• Options are expanding for treating severe obesity in children and adolescents.

Adapted from Charlesworth TES, et al. Psychol Sci. 2019;30:174-192.

Perhaps the biggest change has been the development of a new and growing specialty devoted to this disease – obesity medicine. Just this month, another 772 physicians gained certification in this specialty, bringing the total number of obesity medicine physicians in the United States to more than 4,100.

Most of these physicians come from primary care – internal medicine, family practice, and gynecology. As a result, patients with obesity are looking for physicians who can do more for them than simply advise them to lose weight on their own.

What has stayed the same

Many things are slow to change with respect to obesity. Many providers still misunderstand the physiology of this disease and view it primarily through the lens of behavior. Although behavioral strategies can help a patient cope with this condition, they rarely provide lasting, adequate results alone. That is because obesity is at root a problem of dysregulated metabolism and adipose tissue.

Nonetheless, this misunderstanding is the foundation for pervasive, implicit weight bias. While explicit weight bias has declined, research shows that implicit bias has grown. In part because of this bias, the utilization of intensive behavioral therapy, pharmacotherapy, and bariatric surgery remains low in absolute terms.

What to expect

Options for pharmacotherapy will continue to expand and improve. Drug developers are working toward safe and effective options that can offer effectiveness that approaches the outcomes seen with bariatric surgery. As the specialty of obesity medicine grows and matures, we will see greater utilization of evidence-based therapies for obesity. And finally, basic research is producing a deeper understanding of the diverse etiologies of obesity. From this understanding we will see more targeted therapies arise. One such therapy, setmelanotide, was recently approved by FDA for a fast-track review that might lead to its approval later this year.

The prospects for strides toward better obesity care are bright indeed.

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Ted Kyle is a pharmacist and health innovator living in Pittsburgh. He's also a tireless advocate for people living with obesity. His widely-read daily commentary, published at conscienhealth.org/news, reaches an audience of more than 15,000 thought leaders in health and obesity.
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