The Obesity Epidemic: Get with the Guidelines

What do healthcare providers know about obesity, and how well do they apply current guidelines? That's the questions posed by researchers from the George Washington University, in Washington, DC. The answers—published in the journalObesity—are startling.

Conducted based on previous data that indicated that healthcare providers believe they must discuss obesity with patients and help them pursue appropriate weight reduction strategies, the study found that many, if not most, healthcare providers render care to patients who are overweight is inconsistent with guidelines. The clinical implication is that healthcare providers may be waiting too long to start patients on pharmacotherapy, and delaying interventions for obesity.

These researchers used a nationally representative sample of internists, family practitioners, obstetricians/gynecologists, and nurse practitioners to assess their practice patterns and compare them to guideline recommendations. More than 1500 healthcare providers participated.

These researchers relied on recommendations from 5 individual guidelines that are used often, and evidence-based. These guidelines include the following recommendations:

• Healthcare providers should provide comprehensive, high intensity obesity counseling approximately twice monthly in an individual or group setting for at least 6 months. Outcomes improve when the number of intervention sessions increases.
• Patients need at least 150 minutes per week of moderate intensity exercise.
• Patients who present with BMI exceeding 27 kg/m²and an obesity-associated comorbid condition are appropriate candidates for pharmacotherapy. Those with BMI exceeding 30 kg/m²and no comorbidities are candidates for pharmacotherapy.
• The U.S. Food and Drug Administration considers a weight loss of 5% clinically significant.
• Several weight loss medications can be used on the long-term; healthcare providers should consult each product's labeling for appropriate use.

Survey participants were most likely to know what guidelines to recommend in terms of physical activity, but even in this area, only half of participants knew that patients need approximately 150 minutes of exercise each week. They were least likely to be familiar with counseling recommendations and appropriate use of pharmacotherapy.

A full 20% of survey participants said that they believed that long-term use of drugs used to enhance weight loss is unsafe. Two-thirds of respondents indicated that it is appropriate to continue long-term pharmacotherapy under conditions inconsistent with evidence-based guidelines. Nearly 25% said that even if patients are losing weight while using obesity medications, medications should be discontinued at 3 months. Among the various healthcare providers who responded (family practice physicians, nurse practitioners, internists and OB/GYNs), nurse practitioners were most likely to respond incorrectly to questions about long-term pharmacotherapy for obesity.

The researchers are quick to point out that several organizations have published guidelines to address obesity. Even in this piece, they used the combined recommendations from the 5 guidelines. Multiple guidelines for the same condition can be extremely confusing for healthcare providers. In clinical practice, it's critical for healthcare providers to select the guideline or 2 that they like best, and use them consistently.

Obesity doubles the risk of death before age 70. The condition also increases healthcare costs. Studies indicate that obese individuals incur 42% more healthcare-related costs than those who are not obese.

Reference

Turner M, Jannah N, Kahan S, Gallagher C, Dietz W. Current knowledge of obesity treatment guidelines by health care professionals.Obesity(Silver Spring). 2018 Apr;26(4):665-671.