Why obesity intervention needs to be a bigger part of chronic disease care

Obesity has had an overwhelming presence in the US over the past few decades, but the problem has been exacerbated by the pandemic. The latest CDC data shows that 42% of Americans were obese in March 2020. A survey from the American Psychological Association, conducted last year, found that nearly half of Americans said they had gained more weight than they intended during the pandemic, with the average weight gain being about 30 pounds.

Being obese also makes managing other chronic diseases difficult, be it diabetes, cardiovascular disease or certain cancers. That is why providers and payers must integrate more weight loss strategies in chronic condition care, said Dr. Gabriel Smolarz, an endocrinologist and Novo Nordisk‘s senior medical director for obesity. He recommended doing this during the Chamber of Commerce’s 9th Annual Health Summit held on Tuesday.

dr Smolarz said the healthcare industry has done a poor job of acknowledging obesity’s oversized role in chronic disease outcomes, arguing that “treating the upstream problem can improve the downstream consequences.” Fellow panelist Dr. Amy Frieman, Hackensack Meridian Health‘s chief wellness officer, agreed with Dr. smolz.

“We have to address the entire person — it’s patient centered care,” she said. “When we think about obesity, we need to think about obesity in the same way that we think about any other chronic disease, and that’s by really addressing all of the factors that may lead to that disorder.”

Drs. Frieman and Smolarz declared that weight loss can often play a huge role in decreasing the severity of patients’ chronic conditions. dr Smolarz said that patients only need 5% weight loss one year post-diagnosis to improve chronic conditions like diabetes. He noted that the magnitude of weight loss required increases with certain other conditions, such as fatty liver disease, but weight loss as low as 5% can be significantly meaningful in reducing poor health outcomes.

It’s important to understand that obesity treatment plans will look different for each patient, he said. For example, a physician may give certain cholesterol guidelines to an obese patient who has a heart condition. These guidelines might look different than the weight loss plan for improved fertility that has been assigned to a patient with polycystic ovarian syndrome. Social determinants of health should also always be considered when creating patients’ weight loss plans — physicians must consider things like whether patients have access to healthy food or can travel to a local gym.

Providers must also consider that some patients have genetic factors that make it more difficult for them to lose weight. For these patients, weight loss medication may need to be introduced into their treatment plan. To describe this, Dr. Smolarz proposed the analogy of a patient with severe schizophrenia. The medical industry agrees these patients should receive antipsychotics because no amount of talk therapy alone will be able to cure them of their brain’s chemical imbalance. Similarly, some patients’ genetics make it so that a healthy diet and exercise is not enough to keep weight off, and they may need medication to treat appetite dysregulation, which refers to the body’s abnormalities in regulating metabolic processes. dr Smolarz said these medications could help patients lose weight and therefore experience less chronic disease complications, but health plans usually do not cover them.

“Medicare Part D excludes anti obesity medicines, and that’s super unfortunate because they’re the trendsetter for private payers as well,” he said.

However, payers may wish to buck this trend and take the lead on this instead of waiting for the government to do so. That’s because integrating more obesity treatment plans into chronic condition care is likely to cut overall healthcare expenditures. Medical costs for obese Americans were $1,861 higher than medical costs for Americans who maintained a healthy weight in 2019, according to the CDC.

Photo credit: Flickr user Baratunde Thurston

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