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Current Clinical Challenges in Overweight/Obesity

Advances in the understanding and management of obesity and overweight are summarized based on discussions of an expert panel convened last week by the American College of Physicians. “In closing comments, the panelists expressed great optimism that we are entering an age of increasingly effective therapeutic options for treating overweight and obesity,” the article states. “Increased understanding of the pathophysiology of this complex condition will not only enable the development of new preventive and therapeutic strategies but will also help alleviate weight stigma and bias.”

Major points from the discussion were summarized as follows:

  1. Obesity is a complex condition resulting primarily from an interaction of genes and the environment. 
  2. Effective obesity care demands a multidisciplinary approach. Care should be tailored to individual patients and may require the involvement of primary care physicians, medical subspecialists, surgeons, dietitians, and behavioral and psychiatric health professionals. 
  3. Patients with overweight and obesity suffer from stigma. It is not only the lay public but also clinicians who contribute to this stigma. Physicians and other clinicians must approach discussions of healthy body size with patients without judgment and must avoid blaming and shaming patients. 
  4. We need better measures of overweight and obesity. Body mass index (BMI) is currently used to signal suboptimal body size and eligibility and health care coverage for various treatments. Unfortunately, BMI is an imperfect measure of body composition that differs with ethnicity, sex, body frame, and muscle mass. Some of these limitations have been recognized, with proposed ethnicity-specific criteria for abnormal BMI in persons of Asian ethnicity.
  5. Modification of diet and exercise alone is unlikely to result in long-term benefit. Fewer than 50% of patients who participate in evidence-based, intensive, multicomponent lifestyle interventions lose 5% or more of body weight, and clinicians must recognize that the most effective diet is one that a patient can sustain while limiting calories.
  6. Choosing the best treatment strategy should involve shared decision-making between patients and their clinicians. Patients should receive information about the anticipated benefits and harms of all options—pharmacologic, surgical, and behavioral—for which they are eligible. Pharmacologic therapies are rapidly expanding and currently include buprenorphine–naloxone, orlistat, phentermine–topiramate, liraglutide, and semaglutide.
Source: Annals of Internal Medicine