We hosted a Continuing Medical Education (CME) webinar led by Dr. Angela Fitch (MD, FACP, FOMA), Associate Director of Mass General Weight Center and Vice President of the Obesity Medicine Association. She was kind enough to educate webinar attendees on the evaluation of a patient with obesity, share information about different treatment options for obesity, and discuss the manifestations of obesity-related disease in the primary care setting.
We summarized Dr. Fitch's insights below - be sure to watch the webinar here for the key details and tips shared:
Obesity is defined as a disease in which excess body fat has accumulated to a level that may have an adverse effect on health with three classes that act as a marker for different stages for types of treatments:
Obesity is a chronic treatable disease, but is currently undertreated and overlooked. It is estimated that by 2030 over 50% of the adult population will struggle with obesity. Adult obesity is a pediatric disease and there are significant disparities in obesity, particularly in Hispanic and Black populations who have higher rates than the white population. It should be noted that the majority of obesity is driven by genetics, biology, and environmental factors. Furthermore, currently:
Dr. Fitch suggested applying the 5As of Obesity Management: Asking, Assessing, Assisting, Agreeing & Advising.
Asking a patient, in a thoughtful, non-stigmatic manner, "I'm concerned by how your weight may be affecting your overall health - have you thought about that as well?" Based on the level of readiness of this response, Dr. Fitch usually asks the patient to track their daily habits and food plan to better assess and assist the patient on the best next steps for a clinical workup (follow-up appointment) and determining the patient's health status and the appropriate treatment.
Dr. Fitch's rule of thumb for a "good body fat percentage" for men and women is < 30% (men are a little bit leaner because of their testosterone levels). She also shared that "for every 10 lb of weight that is lost, you can expect 7 lbs of fat lost and 3 lbs of lean muscle mass lost." Measuring body fat can be done through different technologies, such as the Bioimpedance mechanism, the most practical, and the DEXA, the gold standard scale.
Dr. Fitch has found that the combination of medication, behavior modification and meal replacements have the greatest effect on weight loss, while medication alone has the smallest effect on weight loss.
Dr. Fitch emphasized that Behavioral, Medical and Societal are the three key phenotypes for obesity assessment:
Dr. Fitch advises PCPs to discuss these Set Point Factors with their patients to create a realistic weight management treatment plan:
While it is not always linear, Dr. Fitch discussed that there is an Obesity Treatment Pyramid to follow to properly guide and evaluate patients. As health risks and BMI increases, the level of treatment increases, going from lowest health risk to highest health risk of the pyramid: lifestyle modifications for the lowest risk group to prescriptive nutritional intervention to pharmacotherapy to endoscopic procedures and finally, to surgery for the highest risk group.
To learn more about the specific medication and surgical options that Dr. Fitch recommended, watch this webinar.
Kaplan LM, Golden A, Jinnett K, et al. Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study. Obesity. 2017. doi:10.1002/oby.22054.
Scott Kahan, MD, MPH; JoAnn E. Manson, MD, DrPH. Obesity Treatment, Beyond the Guidelines Practical Suggestions for Clinical Practice. 2019. doi:10.1001/jama.2019.2352.
Gelesis100 [Instructions for Use]. Boston, MA: Gelesis; 2019. 2. Greenway FL, et al. Obesity. 2019;27:205-216.