New Obesity Management Guidelines Focus on “Real-World Care”
Even though more than a third of Americans are now classified as obese, many people think of obesity as a temporary battle of the bulge rather than as a serious medical condition. The American Association of Clinical Endocrinologists (AACE) is trying to change this way of thinking by emphasizing that obesity contributes to a host of health complications and warrants medical treatment.
Earlier this year, the AACE issued obesity management guidelines that suggest obesity should be considered a chronic health problem. The guidelines also recommend that obesity treatment be designed with improving a patient’s overall health as the objective, rather than focusing only on weight loss.
“Thinking of obesity as a chronic medical condition can help patients seek medical help for weight management,” says Rachel Lustgarten, RD, CDN, a dietitian with the Comprehensive Weight Control Center at Weill Cornell. “Instead of wasting money on useless and potentially dangerous supplements, quick fixes, and fad diets, people will feel more comfortable receiving medical assistance from a healthcare practitioner when obesity is correctly framed as a chronic health condition.”
Obesity Complications
The guidelines set out to provide “real-world care” for women and men who are obese. The guidelines cover screening, diagnosis, evaluation, treatment decisions, and goals, as well as follow-up care. Among the cornerstones of the AACE’s report are recommendations to screen for 16 weight-related complications, such as pre-diabetes and diabetes, arthritis, pre-hypertension and hypertension, polycystic ovary syndrome, urinary stress incontinence, cardiovascular disease, high cholesterol, and depression.
WHAT YOU CAN DO
- Follow a diet that is primarily composed of vegetables, fruit, whole grains, and lean proteins, with the goal of having five or six servings of fruits and vegetables each day.
- Avoid “high-density” foods that pack in a lot of calories with high fat content. For example, substitute a grilled chicken sandwich and a salad for a cheeseburger and French fries.
- Get at least 30 minutes of activity every day. Stair climbing, brisk walking, dancing, and garden work are all good ideas.
- Look for alternative workouts if you start to get bored with your routine; boredom is a common reason given for why people abandon exercise.
“Most people know that carrying excess weight can contribute to the development of diseases such as diabetes, heart disease, and some cancers,” Lustgarten says. “However, since these conditions take years to develop, the immediate connection between obesity and chronic disease may not always be apparent. The new obesity classification and screening guidelines will be helpful in bringing the importance of obesity treatment more boldly into the public view without stigma.”
Treating Obesity
The AACE devised a formula that takes into account a person’s obesity and any diagnosed, obesity-related complications and comes up with a recommended treatment plan. The AACE guidelines stress that treatment decisions must be made on an individual basis, with all health issues taken into consideration.
For example, someone with obesity and one major obesity-related complication, such as pre-hypertension, may be advised to engage in lifestyle adjustments covering diet, exercise, and smoking cessation. If lifestyle changes don’t result in weight loss and improved blood pressure, one of several approved weight-loss drugs may be prescribed. Bariatric surgery is also considered a reasonable option for very obese individuals whose health is seriously compromised and who have not had success with other weight-loss strategies.
A weight-loss drug may also be advised if you are obese but have no other complications. Researchers say they hope physicians can work these guidelines into their usual office visits and screenings. They also want Medicare and Medicaid, along with private insurers, to start providing better coverage for weight-loss treatments.
Lustgarten says that obesity needs to be treated in an interdisciplinary way, as it is at the Comprehensive Weight Control Center.
“Patients have access to a doctor who assesses their condition and determines what treatment options are appropriate based on factors such as age, health history, and motivation for change,” she explains. “Treatments may include drug therapy and/or bariatric surgery. All patients also work with a registered dietitian to make modifications to lifestyle and eating behaviors. It is crucial that patients are involved in creating the treatment plan so that they are onboard with the changes they are about to undertake. Weight loss and weight maintenance is a journey, and patients must be supported throughout the entire process by healthcare practitioners who are knowledgeable and nonjudgmental.”
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