Frequently asked questions
Get answers to common questions about obesity and learn how to be the best partner and advocate for your patients today
About obesity
Yes, obesity is a chronic, progressive, and prevalent disease.1-3
The American Association of Clinical Endocrinology (AACE) and the American College of Endocrinology (ACE) have published practice guidelines for treating patients with obesity.2
Obesity is one of the most prevalent diseases in the US, affecting more than 109 million (41.9%) adults.4,5
Social determinants of health, environmental factors, and genetics all contribute to obesity.6,7
Specific factors influencing obesity include socioeconomic status and food insecurity (social factors), food availability and quality (environmental factors), and gene mutations (genetic factors).8-11
Even if patients achieve weight loss with reduced-calorie intake, metabolic adaptation to appetite-regulating hormones drives weight regain and persists, making long-term weight management very challenging.11,12
Yes, cardiovascular mortality rates climb 7% for every 2 years lived with obesity.13*
*Based on data from the original cohort study of the Framingham Heart Study (FHS). This cohort study followed 5,209 participants (aged 28-62 years at the time of enrollment) for approximately 48 years beginning in 1948 with examinations at 2-year intervals. The current study included only participants who were free from preexisting diseases of diabetes, cardiovascular diseases, and cancer at baseline (n=5,036).13
CV, cardiovascular.
Obesity has negative effects on mental health and influences health status both directly and indirectly. The impact of overweight and obesity on mental health includes depression, body image dissatisfaction, eating disorders, and stress.14
Talking with your patients
As obesity rates have risen in the last several decades, so has the evidence of weight stigma and weight bias. In fact, weight discrimination in the US is commonly reported at rates comparable with those of racial discrimination.14
You may want to consider pharmacological treatments for your patients with overweight or obesity who2:
- Have tried lifestyle changes but can’t reach a healthier weight
- Are having difficulty with weight management
- Have a BMI of ≥27 kg/m2 and a weight-related comorbidity
- Have a BMI that is ≥30 kg/m2
BMI, body mass index.
Consider the 5As model, a behavioral intervention strategy that has been modified for obesity management. It helps increase patient motivation and behavior change in weight-management consultations.15
ASK for permission to discuss weight
ASSESS obesity class and stage
ADVISE on obesity risks
AGREE on realistic weight-loss expectations
ASSIST by providing education, resources, and support
Having a conversation focused on weight history can serve as a helpful complement to a full clinical and physical assessment before starting a weight-management plan. Some topics to consider when beginning a weight-history discussion include:
- Changes in weight over time
- Factors in weight changes
- Descriptions of past weight-management efforts
- Current habits
While many of your patients may have greater weight-loss goals, a study showed that a modest weight loss of 5% or more can have a clinically meaningful impact.16
In the study, weight loss of 5% was associated with improvement in cardiovascular risk factors such as glycemic control, blood pressure, HDL cholesterol, and triglycerides.16
Studies also show that higher levels of weight loss can be associated with greater improvements in some comorbidities. Be sure to emphasize the difference that a weight loss of 5% or more can make in reducing the risk of comorbid conditions.16
HDL, high-density lipoprotein.
SMART goals help patients clearly define their weight-management objectives. To be SMART, a goal is17:
Specific
- Focuses on a specific behavior or accomplishment
Measurable
- Provides a framework to measure accomplishments
Achievable
- Recognizes the time frame and resources available to the patient
Relevant
- Remains true to the problem at hand
Time-Bound
- Describes the time frame within which the objective is to be achieved
The Obesity Treatment Modules Educational Series provides practical tools designed for health care professionals and their office staff who want to learn how to provide quality care for their patients with obesity. In this series, Dr. Robert Kushner and Dr. Michael Kaplan will walk you through strategies and tips for diagnosing and discussing obesity with your patients, covering topics such as billing and coding documentation, motivational interviewing, goal setting, building a weight-management plan, and addressing weight plateau and weight regain.
Support for people with obesity
Obesity is a chronic, progressive, and prevalent disease that requires long-term management, but many people with obesity still lack the support they need to manage their weight.1,3,18 By partnering with your patients to develop comprehensive and individualized approaches to weight loss and weight management, you can make a huge impact on your patients’ lives and help fill the gaps in their health care that are keeping them from successful weight loss.
You can contact the Obesity Care Advocacy Network (OCAN) to advocate for individual patients, reach out to legislators, understand current policy, and more.
Obesity in adolescence is on the rise, with a 3-fold increase in prevalence since the 1970s.19 Many of the weight-related conditions we see in the adult population, like hypertension, type 2 diabetes, and dyslipidemia, are now becoming more common in people younger than 18 years of age who have obesity. Because obesity is a chronic condition, ongoing monitoring and treatment are required, which may include intensive lifestyle modification, pharmacotherapy, or even surgical intervention.20
Cultural influences, such as traditions and views about body image, can impact whether or not your patients will accept your weight-management advice. Understanding your patients’ cultural nuances can help you create a plan that fits their lifestyles.
Obesity is associated with at least 60 serious comorbidities that include obstructive sleep apnea (OSA), type 2 diabetes, prediabetes, dyslipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), female infertility, hypertension, osteoarthritis, polycystic ovary syndrome (PCOS), and many more.1,2,16,21 Yet, studies have shown that weight loss of as little as 5% can help improve many of those comorbidities.15
OBESITY TREATMENT MODULES
Access modules to test your knowledge
INITIATING A PLAN
You can help your patients achieve continued success in weight management
References:
1. Tondt J, Freshwater M, Hurtado Andrade M, et al. Obesity algorithm 2024. Obesity Medicine Association. January 2024. Accessed March 28, 2024. https://obesitymedicine.org/resources/obesity-algorithm
2. Garvey WT, Mechanick JI, Brett EM, et al; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203.
3. Centers for Disease Control and Prevention. Adult obesity facts. Published May 14, 2024. Accessed June 5, 2024. https://www.cdc.gov/obesity/php/data-research/adult-obesity-facts.html
4. Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey: 2017–March 2020 prepandemic data files—development of files and prevalence estimates for selected health outcomes. National Health Statistics Reports No. 158. June 14, 2021. Accessed September 18, 2024. https://www.cdc.gov/nchs/data/nhsr/nhsr158-508.pdf
5. US Census. Quick facts. Accessed July 16, 2024. https://www.census.gov/quickfacts/fact/table/US/LND110210
6. Thaker VV. Genetic and epigenetic causes of obesity. Adolesc Med State Art Rev. 2017;28(2):379-405.
7. Gilmore LA, Duhe AF, Frost EA, Redman LM. The technology boom: a new era in obesity management. J Diabetes Sci Technol. 2014;8(3):596-608.
8. Masood M, Aggarwal A, Reidpath DD. Effect of national culture on BMI: a multilevel analysis of 53 countries. BMC Pub Health. 2019;19(1):1212.
9. Hemmingson E, Nowicka P, Ulijaszek S, Sorensen TIA. The social origins of obesity with and across generations. Obesity Rev. 2023;24:e13514.
10. Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Glob Health. 2022;7:e009773.
11. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604.
12. Lam YY, Ravussin E. Indirect calorimetry: an indispensable tool to understand and predict obesity. Eur J Clin Nutr. 2017;71(3):318-322.
13. Abdullah A, Wolfe R, Stoelwinder JU, et al. The number of years lived with obesity and the risk of all-cause and cause-specific mortality. Int J Epidemiol. 2011;40(4):985-996.
14. Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming weight bias in the management of patients with diabetes and obesity. Clin Diabetes. 2016;34(1):44-50.
15. Agency for Healthcare Research and Quality. Five major steps to intervention (The "5 As"). Accessed October 8, 2024. https://www.ahrq.gov/prevention/guidelines/tobacco/5steps.html
16. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187-194.
17. Centers for Disease Control and Prevention. Writing SMART objectives. Published August 2018. Accessed May 17, 2024. https://www.cdc.gov/healthyyouth/evaluation/pdf/brief3b/pdf
18. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440-2450.
19. Fryar CD, Carroll MD, Afful J; Division of Health and Nutrition Examination Surveys. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2017-2018. Centers for Disease Control and Prevention. 2020. Updated February 8, 2021. Accessed August 30, 2024. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity-child.htm
20. Hampl S, Hassink S, Skinner A, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640.
21. Centers for Disease Control and Prevention. Obesity and cancer. Published November 7, 2023. Accessed May 17, 2024. https://www.cdc.gov/cancer/risk-factors/obesity.html
