Implementation of Obesity Science Into Clinical Practice: Key Points

Laddu D, Neeland IJ, Carnethon M, et al.
Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association. Circulation 2024;May 20:[Epub ahead of print].

The following are key points to remember from an American Heart Association scientific statement on the implementation of obesity science into clinical practice:

  1. The prevalence of obesity has been increasing for decades, with an estimated 40% of US adults living with obesity. This has likely contributed to a slowing in the decline of cardiovascular disease (CVD).
  2. Effective implementation of obesity science into routine clinical care for both the prevention and management of obesity is currently suboptimal.
  3. Health care providers must have the knowledge to understand the prevention and management of obesity. Missed opportunities for provider education occur at multiple levels, including professional certification activities, which provide ongoing education. Also lacking is the paucity of obesity-related education at the medical school or resident trainee levels.
  4. The Society for Behavioral Medicine has developed an evidence-based model for primary care obesity management based on the 5As counseling framework. The 5As are assess, advise, agree, assist, and arrange. This model may include referral to counseling programs to supplement brief office-based counseling.
  5. Lifestyle counseling is an important component in the prevention and management of obesity. However, barriers include a lack of clinician comfort in counseling and a lack of referral resources. Approximately 50% of patients believe their providers did not understand the challenges of being overweight or obese or losing weight. 30% of patients report that their providers did not discuss resources for weight management.
  6. A patient’s social environment significantly influences weight. Sustainable clinic-community linkages are foundational for sustained prevention and management of obesity.
  7. Newer pharmacologic therapies have demonstrated significant weight loss in populations, including those with CVD. However, such medications continue to be underprescribed. Barriers include clinician-based knowledge gaps, concerns regarding safety, and coverage limitations.
  8. Surgical treatments such as bariatric surgery have become safer and more effective. However, access barriers remain a challenge for many.
  9. Knowledge gaps also exist regarding the cost-effectiveness of many obesity therapies. Additionally, the use of technologies, such as weight loss apps or telemedicine, has been understudied. These technologies may improve the reach of obesity treatment for underserved groups, including rural residents.
  10. Public policy changes are essential to increase the provision of available evidence-based strategies to larger populations. At the same time, understanding how to implement and scale effective programs is also important.

Clinical Topics: Prevention

Keywords: Implementation Science, Obesity

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