There is a huge gap between the science of obesity and the care patients receive.

“Obesity is undoubtedly a significant public health concern in the United States and around the world, affecting nearly all populations and straining health care systems,” said FAHA Chairman of the Statement Committee. said Dr. Deepika Radu, senior researcher. Scientist at the Arbor Research Collaborative for Health in Ann Arbor, Michigan. “Obesity, as a major risk factor for heart disease, has significantly hindered progress in reducing heart disease rates. Despite advances in understanding the complexity of obesity and new treatment options, obesity research and practice are Significant gaps remain between clinical practice.”

Research shows that intensive lifestyle therapy is significantly more effective at weight loss than simple advice from a medical professional. However, general educational information is more often provided by health professionals than referrals to classes, programs, or specific resources for making lifestyle changes. One study found that only 16% of health professionals have a working knowledge of evidence-based lifestyle treatments for obesity, including diet and nutrition, physical activity, and referral to intensive behavioral treatments. has become clear. Other barriers to weight loss efforts are exacerbated by socioeconomic and racial or ethnic inequalities. People of diverse races and ethnicities and those covered by Medicare and Medicaid are less likely to be referred to weight management programs or covered by insurance.

The number of people living with obesity is increasing worldwide. For nearly 30 years, the obesity epidemic has been escalating in the United States and around the world. According to the Centers for Disease Control and Prevention, recent estimates indicate that more than 40% of U.S. adults aged 20 years and older are obese.

Research has led experts to unravel the multifactorial causes of obesity, including sociological and physiological determinants of health. Treatments for obesity are also evolving, with an increasing number of strategies including lifestyle modification, pharmacotherapy, and bariatric surgery. However, each treatment approach presents challenges.

“While great advances have been made in helping us understand obesity, there remains a huge gap between what we know and what's happening in the clinic,” Radu said. “Health care professionals and health systems need to find better ways to put knowledge about obesity into practice so that more people receive the support and treatment they deserve. Introducing new technologies and telemedicine and introduce community-based weight management programs to promote obesity.'' Behavioral change, provision of social support, and increased access and access to treatment make for successful evidence-based obesity care. These are just some of the promising ways we can implement this. ”

weight loss drugs

Glucagon-like peptide-1 (GLP-1) agonists, such as high-dose semaglutide and tirzepatide, are recently FDA-approved drugs for long-term weight management, and both are associated with weight loss over an average of 10 years. % at 6 months in clinical studies. However, even though half of adults in the United States meet BMI obesity criteria and are eligible to receive these drugs, only a small portion of this population currently takes these drugs. Until recently, the main barriers to expanded use of antiobesity drugs have been the lack of insurance coverage and the high out-of-pocket costs of these drugs.

Since the inception of the Medicare (Part D) program in 2006, all medications taken for weight loss have been excluded from basic coverage. In March, the Centers for Medicare and Medicaid Services (CMS) decided that Medicare and Medicaid could cover the anti-obesity drug semaglutide if its additional use was approved by the FDA. The decision included the administration of high-dose semaglutide, which is approved by the FDA for weight loss and reducing the risk of cardiovascular death, heart attack, and stroke in adults who have cardiovascular disease and are obese or overweight. State Medicaid programs, which provide health insurance to low-income people disproportionately affected by obesity and heart disease, are mandated to cover nearly all FDA-approved anti-obesity medications for people who meet health and body mass index (BMI) standards. However, state health plans may require step therapy with other treatments or medications before approving the use of GLP-1 drugs.

“FDA approval and insurance coverage of the latest treatments, including GLP-1 therapeutics, are essential to improving access to and outcomes for those who need these treatments most. , for patients at high risk and high need for treatment. These measures to increase access to prevention of adverse cardiovascular events could potentially reduce CVD risk and outcomes for millions of adults in the United States. “We are encouraged that this may lead to improvements in clinical outcomes,” said Ian J. Kneeland, MD, FAHA, vice chair of the scientific statement. Director of Cardiovascular Prevention, University Hospital Harrington Heart and Vascular Institute Director, Center for Vascular Metabolic Disease Integrative and Novel Approaches, Case Western Reserve Diabetes, Obesity, and Metabolism Case Center Associate Professor of Medicine, University School of Medicine, both in Cleveland.

weight loss surgery

In the decades since bariatric (weight loss) surgery was first introduced as an option for patients with severe obesity, surgical expertise and safety have advanced, and so has our understanding of the health benefits that often follow obesity. Ta. Surgery. A comprehensive review of studies focused on weight loss surgery found that patients who underwent bariatric surgery had a lower risk of cardiovascular disease and multiple other obesity-related diseases, including type 2 diabetes and hypertension. It was shown. One of the challenges facing medical professionals is ensuring that bariatric surgery is accessible to those with the greatest need in terms of cost, resources, and social support.

This statement describes strategies to address these challenges and improve how obesity-based research is incorporated into clinical care. This statement also highlights the need to develop population-wide solutions to manage obesity at the community level. Potential improvements in public health policy and future research to expand patient care models and optimize equitable obesity-related care delivery and sustainability are suggested.

The statement highlights specific approaches to bridging the gap between obesity science and clinical care, including:

• To reach and make the right impact for people in need, health care professionals must consider insurance type, household income, race and ethnicity, environment, health literacy, access to health-promoting resources, social support, and more. We need to consider how all the social determinants of health affect the likelihood of: Successful patient treatment.
• Describes education for health professionals that explains the complex causes and clinical consequences of obesity. Such training should focus on information about obesity diagnosis, prevention, and treatment. Despite the global obesity epidemic, there is a lack of obesity education programs for health professionals.
• Further evaluate health policy changes that health systems and insurance plans can implement and expand to make obesity treatment more affordable for patients, especially those at high risk for adverse outcomes such as cardiovascular disease.
• Frameworks for bringing obesity treatment into clinical practice are being considered, as well as efforts by some professional societies to develop interventions that make obesity treatment more accessible.

“This statement emphasizes the importance of a comprehensive approach across different levels of health care delivery and public policy, along with the adoption of actionable evidence-based strategies in clinical practice,” Radu said. . “It also highlights the need for future research and policy changes to improve current patient care models and ensure people from underrepresented groups have equitable access to obesity-related care. ”

The scientific statement also provides possible solutions on how to support people in their daily lives, such as digital technology interventions and telemedicine access. However, the science and treatment of obesity requires further research. Limited understanding of the cost-effectiveness of obesity prevention and the long-term health effects of established treatments hinders the translation of obesity science into clinical practice. Collaborative obesity science research between stakeholders and health economists can serve as a bridge to the development and expansion of cost-effective prevention programs.

Further research into the “Food Is Medicine” approach in health care, such as medically tailored diets and prescriptions for preventing and treating cardiovascular and other diet-related diseases, is also being explored in several settings, including the Association's “Healthcare Through Food.”^TM Initiative.

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association Obesity Committee of the Council on Lifestyle and Cardiometabolic Health. Council on Epidemiology and Prevention. Clinical Cardiology Council, Hypertension Council. Council on Kidney in Cardiovascular Disease. and the Cardiovascular and Stroke Nursing Council. American Heart Association scientific statements help raise awareness about cardiovascular disease and stroke issues and promote informed medical decisions. A scientific statement outlines what is currently known about a topic and areas where additional research is needed. Scientific statements serve to create guidelines, but do not recommend treatments. American Heart Association guidelines provide the association's official clinical practice recommendations.

Additional co-authors and writing group members are Dr. Mercedes Carnethon, FAHA; Fatima C. Stanford, MD, MPH, MPA, MBA, FAHA. Dr. Morgana Mongrow Chaffin, FAHA; Dr. Bethany Baron Gibbs, FAHA. Chiadi E. Ndumele, MD, Ph.D., FAHA. Chris T. Longenecker, MD, FAHA. Misuk L. Chan, Ph.D., RN, FAHA.and Dr. Gowtham Rao