- Email: [email protected]
Obesity Medicine: A Core Competency for Primary Care Providers
---
Preface Obesity Medicine: A Core Competency for Primary Care Providers
Scott Kahan, MD, MPH Robert F. Kushner, MD Editors
Few medical topics are more important to be addressed in primary care than obesity. Nearly 40% of American adults have clinical obesity; 70% have a body mass index greater than 25 kg/m2.1 Obesity increases the risk for hundreds of diseases, disability, impaired quality of life, and premature mortality, and strikingly increases health care costs.2–6 With such a large proportion of Americans being affected by obesity and its associated conditions, the primary care workforce is best positioned to lead the way toward progress. Unfortunately, that has not been the case. Primary care providers have minimal training and confidence in addressing obesity, and medical credentialing examinations do not sufficiently include questions testing obesity knowledge.7–9 Few patients with obesity receive screening and documentation of obesity in primary care, let alone receive counseling or evidence-based treatment for obesity.10–12 For these reasons, this issue of Medical Clinics of North America focuses on obesity medicine in primary care, offering health care providers guidance on addressing the range of issues surrounding obesity. The initial articles in this issue describe the current state of obesity in 2017, including updated information on the national and international burden of obesity, staging of obesity, models of care, and the (relatively) newly formed specialty of obesity medicine; why obesity should be treated as a disease, including an updated review of causes and mechanisms of obesity and pathways through which obesity leads to comorbidities; and overviews of principles of obesity treatment in primary care and published obesity treatment guidelines. We then review management of obesity in two special populations: older adults and pregnancy, reviewing patient assessment, goals of treatment, and nuances of treatment for each unique patient population. From there, several articles review a range of treatment modalities from Med Clin N Am - (2017) -–https://doi.org/10.1016/j.mcna.2017.09.003 0025-7125/17/ª 2017 Published by Elsevier Inc.
medical.theclinics.com
ii
Preface
the perspective of the primary care provider: nutrition and lifestyle management, behavioral counseling for obesity, obesity pharmacotherapy, medical devices for obesity treatment, and bariatric surgery. Finally, we conclude with an offering on weight maintenance and long-term management, offering perspectives of both physiology and behavior. We hope this issue of Medical Clinics of North America will be a valuable resource for primary care clinicians, and we hope to see many more publications on this important topic in the future. Scott Kahan, MD, MPH National Center for Weight and Wellness Strategies To Overcome and Prevent (STOP) Obesity Alliance George Washington University Milken Institute School of Public Health The Obesity Society 1020 19th Street NW, Suite 450 Washington, DC 20036, USA Robert F. Kushner, MD Northwestern University Feinberg School of Medicine Northwestern Center on Obesity 750 North Lake Shore Drive Rubloff 9-976 Chicago, IL 60611, USA E-mail addresses: [email protected] (S. Kahan) [email protected] (R.F. Kushner) REFERENCES
1. Flegal KM, Knuszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005-2014. J Am Med Assoc 2016;315(20):2284–91. 2. Yuen M, Earle R, Kadambi N, et al. A systematic review and evaluation of current evidence reveals 236 obesity-associated disorders. New Orleans (LA): The Obesity Society; 2016. p. T-P-3166. 3. Batsis JA, Zbehlik AJ, Barre LK, et al. Impact of obesity on disability, function, and physical activity: data from the Osteoarthritis Initiative. Scand J Rheumatol 2015;44:495–502. 4. Kushner RF, Foster GD. Obesity and quality of life. Nutrition 2000;16:947–52. 5. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity and mortality (BMI of 40-59 kg/m2): a pooled analysis of 20 prospective studies. PLoS Med 2014;11(7):e1001673. 6. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011;12(2):131–41. 7. Petrin C, Kahan S, Turner M, et al. Current attitudes and practices of obesity counselling by health care providers. Obes Res Clin Pract 2016;11(3):352–9. 8. Gunther S, Guo F, Sinfield P, et al. Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities. Qual Prim Care 2012;20(2):93–103.
Preface
9. Kushner RF, Butsch WS, Kahan S, et al. Obesity coverage on medical licensing examinations in the United States. What is being tested? Teach Learn Med 2017; 29(2):123–8. 10. Post RE, Mainous AG 3rd, Gregorie SH, et al. The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med 2011;171(4):316–21. 11. Bardia A, Holtan SG, Slezak JM, et al. Diagnosis of obesity by primary care physicians and impact on obesity management. Mayo Clin Proc 2007;82(8):927–32. 12. Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care 2013; 51(2):186–92.
iii
Preface Obesity Medicine: A Core Competency for Primary Care Providers
Scott Kahan, MD, MPH Robert F. Kushner, MD Editors
Few medical topics are more important to be addressed in primary care than obesity. Nearly 40% of American adults have clinical obesity; 70% have a body mass index greater than 25 kg/m2.1 Obesity increases the risk for hundreds of diseases, disability, impaired quality of life, and premature mortality, and strikingly increases health care costs.2–6 With such a large proportion of Americans being affected by obesity and its associated conditions, the primary care workforce is best positioned to lead the way toward progress. Unfortunately, that has not been the case. Primary care providers have minimal training and confidence in addressing obesity, and medical credentialing examinations do not sufficiently include questions testing obesity knowledge.7–9 Few patients with obesity receive screening and documentation of obesity in primary care, let alone receive counseling or evidence-based treatment for obesity.10–12 For these reasons, this issue of Medical Clinics of North America focuses on obesity medicine in primary care, offering health care providers guidance on addressing the range of issues surrounding obesity. The initial articles in this issue describe the current state of obesity in 2017, including updated information on the national and international burden of obesity, staging of obesity, models of care, and the (relatively) newly formed specialty of obesity medicine; why obesity should be treated as a disease, including an updated review of causes and mechanisms of obesity and pathways through which obesity leads to comorbidities; and overviews of principles of obesity treatment in primary care and published obesity treatment guidelines. We then review management of obesity in two special populations: older adults and pregnancy, reviewing patient assessment, goals of treatment, and nuances of treatment for each unique patient population. From there, several articles review a range of treatment modalities from Med Clin N Am - (2017) -–https://doi.org/10.1016/j.mcna.2017.09.003 0025-7125/17/ª 2017 Published by Elsevier Inc.
medical.theclinics.com
ii
Preface
the perspective of the primary care provider: nutrition and lifestyle management, behavioral counseling for obesity, obesity pharmacotherapy, medical devices for obesity treatment, and bariatric surgery. Finally, we conclude with an offering on weight maintenance and long-term management, offering perspectives of both physiology and behavior. We hope this issue of Medical Clinics of North America will be a valuable resource for primary care clinicians, and we hope to see many more publications on this important topic in the future. Scott Kahan, MD, MPH National Center for Weight and Wellness Strategies To Overcome and Prevent (STOP) Obesity Alliance George Washington University Milken Institute School of Public Health The Obesity Society 1020 19th Street NW, Suite 450 Washington, DC 20036, USA Robert F. Kushner, MD Northwestern University Feinberg School of Medicine Northwestern Center on Obesity 750 North Lake Shore Drive Rubloff 9-976 Chicago, IL 60611, USA E-mail addresses: [email protected] (S. Kahan) [email protected] (R.F. Kushner) REFERENCES
1. Flegal KM, Knuszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005-2014. J Am Med Assoc 2016;315(20):2284–91. 2. Yuen M, Earle R, Kadambi N, et al. A systematic review and evaluation of current evidence reveals 236 obesity-associated disorders. New Orleans (LA): The Obesity Society; 2016. p. T-P-3166. 3. Batsis JA, Zbehlik AJ, Barre LK, et al. Impact of obesity on disability, function, and physical activity: data from the Osteoarthritis Initiative. Scand J Rheumatol 2015;44:495–502. 4. Kushner RF, Foster GD. Obesity and quality of life. Nutrition 2000;16:947–52. 5. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity and mortality (BMI of 40-59 kg/m2): a pooled analysis of 20 prospective studies. PLoS Med 2014;11(7):e1001673. 6. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011;12(2):131–41. 7. Petrin C, Kahan S, Turner M, et al. Current attitudes and practices of obesity counselling by health care providers. Obes Res Clin Pract 2016;11(3):352–9. 8. Gunther S, Guo F, Sinfield P, et al. Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities. Qual Prim Care 2012;20(2):93–103.
Preface
9. Kushner RF, Butsch WS, Kahan S, et al. Obesity coverage on medical licensing examinations in the United States. What is being tested? Teach Learn Med 2017; 29(2):123–8. 10. Post RE, Mainous AG 3rd, Gregorie SH, et al. The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med 2011;171(4):316–21. 11. Bardia A, Holtan SG, Slezak JM, et al. Diagnosis of obesity by primary care physicians and impact on obesity management. Mayo Clin Proc 2007;82(8):927–32. 12. Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care 2013; 51(2):186–92.
iii