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Inertia in Obesity Treatment
Contemporary Obesity Treatment: Caught in Clinical Inertia

Released: March 27, 2020

Expiration: March 26, 2021

Caroline Apovian
Caroline Apovian, MD
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Despite more than 40% of adults in the United States living with obesity, a rate that has been increasing for more than a decade, healthcare providers find themselves in a climate of inertia around treating this common, chronic disease. The problem stems from several barriers to improving obesity treatment, including a lack of prescriptive guidelines, a cultural mindset around weight and weight loss, and cost.

Lack of Prescriptive Guidelines
For chronic diseases like hypertension and diabetes, practice guidelines and standards of care are prescriptive. They clearly state that you should not let a patient leave your office without addressing their high blood pressure or high blood sugar.

By contrast, based on current guidelines, primary care physicians and other specialists do not have to treat obesity. If we see a patient with obesity in our clinic, we can treat their comorbid conditions such as high blood pressure or diabetes without ever addressing their BMI. No one is penalized for neglecting to treat the obesity.

Cultural Mindset
Part of the reason we lack clear standards of practice for managing obesity is the lack of universal recognition of obesity as a disease; that’s a big problem for clinicians and patients, especially those patients who typically do not consider their obesity to be a disease requiring medical intervention.

Among patients who are eligible to receive bariatric surgery, only 1% to 2% undergo these procedures every year, despite most third-party payers offering coverage. When I encounter patients with extreme obesity and recommend bariatric surgery procedures as a viable option for them to lose the weight and keep it off, they frequently decline surgery, convinced that they should be able to lose weight on their own.

To pose a stark example of how we treat obesity vs other chronic conditions

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