Early Intervention in Weight Management: Treating Pre-Obesity

April 29, 2021
Michelle L. Look, MD

Research shows that increased risk of chronic disease and mortality begins below a BMI classified as obesity. The earlier we intervene with at-risk patients, the greater the chance for success.

As health care providers, we are accustomed to treating patients with obesity (body mass index [BMI] of ≥30 kg/m²) and the associated comorbidities. Helping these high-risk patients navigate their health issues and offering clinical support is what we do every day.

However, research shows that clinicians can positively impact outcomes by taking a more proactive approach before overweight becomes obesity, ie, by treating pre-obesity, classified by the World Health Organization as BMI 25.0–29.9 kg/m2.

Recognize the risk

Research has shown that the risk of increased chronic disease and mortality starts at a BMI lower than that which defines obesity. According to The Global BMI Mortality Collaboration Trial, the relationship between BMI and all-cause mortality and cause-specific mortality has a J-shaped curve with the change point at a BMI of 25 kg/m², or pre-obesity, not at 30 kg/m². This BMI benchmark is a call to action for providers to intervene earlier with education for patients whose weight is trending upward, especially as studies show many patients with pre-obesity will transition to obesity.

It is estimated that, taken together, pre-obesity and obesity affect >73% of US adults, creating a health issue that is considered an epidemic in this country. Patient education should begin with alerting patients who have a BMI of ≥25 kg/m² of the significant health risks associated with pre-obesity. Patients may take their increased weight more seriously and be motivated to work to prevent the transition to obesity when they understand the potential medical consequences.

It is important that patients understand the benefits of even a 5% to 10% loss of original body weight. To help increase success, a comprehensive weight loss treatment plan, including lifestyle changes and behavior modification, as well as FDA-approved medications where appropriate, should be long-term with regular physician follow-up.

Take it step-by-step

Working with patients who struggle with overweight of any magnitude is often complicated. Obesity is a chronic, relapsing disease impacted by family history, lifestyle, environmental factors, pre-existing conditions, and psychological issues. Although it may be challenging to treat patients with obesity, using evidence-based strategies and principles of chronic disease management, we can help patients achieve significant health improvements and avoid complications.

Tips you may want to share with patients to get started:

  • A single diet plan does not work for everyone, but reducing calories is necessary
  • Keeping a detailed food diary may be helpful
  • Increasing physical activity can start with a little bit every day
  • Support groups, both in person and online, can help maintain motivation

As more research is conducted on the factors associated with and the consequences of pre-obesity, more information will be available to help primary care providers support their at risk patients.

More information on treatment for obesity and how to become a member of the Obesity Medicine Association can be found here.

Michelle L. Look MD joined San Diego Sports Medicine & Family Health Center in 2001 after completing the Primary Care Sports Medicine fellowship program and Family Practice residency at Sharp Healthcare in San Diego. Dr Look is board certified in family medicine and obesity medicine, with qualifications in sports medicine. She has been a team physician for the United States in several Olympic Games and is currently a staff physician for the US Olympic Training Center in Chula Vista and a team physician for the USA Men’s and Women’s Rugby Sevens Team.