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Overview of Obesity Management in Primary Care



sharma-obesity-doctor-kidGiven the vast number of individuals who could potentially benefit from effective long-term obesity management, there is no option but to manage most of this problem in primary care settings.

While this approach can be highly effective, it does require training, resources and ongoing (lifelong?) interventions (not unlike most other chronic diseases).

Now a rather comprehensive paper by Soleyman and colleagues from the University of Birmingham, Alabama, published in Obesity Reviews provides an overview of obesity management in primary care.

As readers are well aware, our body weight are tightly regulated by a complex neuroendocrine system and defends us agains weight loss through a multi-faceted physiological response to prevent further weight loss and restore body weight.

As the authors note,

“To maintain weightloss, individuals must adhere to behaviours that oppose these physiological adaptations and the other factorsfavouring weight regain. However, it is difficult for peoplewith obesity to overcome physiology with behaviour over the long term. Common reasons for weight regain include decreased caloric expenditure, decreased self-weighing frequency, increased caloric intake, increased fat intake and eating disinhibition over time.”

The paper provides a succinct overview of the evidence supporting behavioural, medical and surgical obesity treatments.

It also reiterates the basic principles of obesity management as outlined in the various guidelines:

1. Obesity is a chronic disease that requires long-term management. It is important to approach patients with information regarding the health implications.

2. The goal of obesity treatment is to improve the health of the patient, and it is not intended for cosmetic purposes.

3. The cornerstone of therapy is comprehensive lifestyle intervention from informed PCPs or other healthcare professionals.

4. The initial goal of therapy is a weight loss of 5–10% in most patients, as this is sufficient to ameliorate many weight-related complications. However, weight loss of ≥10% may be needed to improve certain weight-related complications, such as obstructive sleep apnoea.

5. Consideration should be given to the use of a weight-loss medication or possible bariatric surgery, as the addition of these treatment modalities to lifestyle therapy can promote greater weight loss and maintain the weight loss for a longer period of time.

6. It is important for clinicians to evaluate the patient for weight-related complications, that can be improved by weight loss, and to consider such patients for more aggressive treatment.

These recommendations (with minor variations) are also very much in line with the 5As of Obesity Management framework championed by the Canadian Obesity Network.

As for how to get more primary care clinics to actually implement these approaches, the authors note that,

“Primary care practitioners need to address the problem of obesity in their patients, just as they would with any other chronic condition such as hypertension or type 2 diabetes, and to ensure that their patients are aware of the health risks of obesity.”

Again something that the Canadian Obesity Network is working hard to promote in this country.

@DrSharma
Edmonton, AB

1 Comment

  1. Thank you Dr. Sharma for sharing the post. I got really excited when I saw the title “weight maintenance” and “primary care”, I have lots of respect to Dr. Garvey but reading the article left me with mixed feelings. I am a family physician also board certified in obesity medicine. I do believe very strongly in need to find new models of care for weight management to help both patients and physicians with the new tools now available including medications.
    Weight maintenance was defined nicely in the article and listed evidence based medicine benefits very convincingly. Then the authors went into the lifestyle component of successful treatment per literature. The transition to pathophysiology and pharmacology was nicely outlined, which I as a practicing physician think is where the current patterns are headed. Surgery section ended with mention of “regains” which I think is part of this long term maintenance dilemma.
    Models and guidelines? the best words here were “1. Obesity is a chronic disease.” But did we expect the systemic search of literature to have more answers or would we need to build new models using the current obesity guidelines and treatment tools?
    Mohammed Tarrabain, MD
    Indianapolis,USA

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