Approach to Obesity Treatment in Primary Care: A Review

Watch as Dr. Susan Z. Yanovski and Dr. Jack A. Yanovski of the National Institutes of Health share their expertise on weight management strategies. With 40% of U.S. adults being affected by obesity, they outline a roadmap for primary care physicians to effectively integrate lifestyle modifications and weight management medications into patient care.
They also discuss a flowchart that healthcare providers can use to make decisions with patients about weight management medications and emphasize the importance of making patient care more respectful, effective, and inclusive.
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Transcript:
SUE YANOVSKI: We wrote this paper because with 40% of US adults having obesity, virtually every primary care practice will be treating patients with obesity. And now with more effective treatments available, we wanted to provide an actionable roadmap to primary care physicians for how they can help their patients and integrate obesity care into their clinical practice.
JACK YANOVSKI: Well, what we found when we reviewed the literature on obesity is that first, there's a lot of information about how to assess the problems that obesity may lead to. And physicians do a great job of determining whether people have, say diabetes or high blood pressure. But what there seem to be less information on is how to use the brand new medicines that have been approved by the Food and Drug Administration over the last few years.
SUE YANOVSKI: Lifestyle treatments for obesity that encourage improved diet and physical activity are really a cornerstone. They're foundational for any obesity treatment. However, lifestyle treatment alone leads to an average of 2% to up to 9% of initial weight loss over time. And many patients can't even achieve that much weight loss. Or if they do they regain that weight loss over time. Bariatric surgery is much more effective in terms of larger weight losses and more sustained weight loss. But that's invasive and it's really not right for every patient. That's one of the reasons that anti-obesity medications can play a role in bridging the gap between what we can achieve with lifestyle treatments and more invasive procedures like bariatric surgery.
JACK YANOVSKI: And that's not to say that medicines are for everyone. They're not for every adult, and they're certainly not for every adolescent. And it's a very individual decision that a family and child need to make based on where they are, what they're thinking, what they think is important to them. So it's shared decision-making all the way when it comes to using medicines for anybody under 18. And even for adults, it's very important that doctors are not being just prescriptive. They should be discussing with their patients and trying to see if they really want to engage in medicine or even surgery to try to get control of body weight.
SUE YANOVSKI: In our paper, we actually have a flowchart, in order to assist the primary care physician in helping the patients make a decision using shared decision-making, when to consider using anti-obesity medications, how to use them effectively, for example, what to do if a patient is not losing weight or has intolerable side effects, and when you need to call in a specialist.
SUE YANOVSKI: We believe that most primary care clinicians can provide effective care for their patients with obesity, can institute using anti-obesity medications with some guidance. So what we've tried to do is help clinicians to feel more comfortable with treating their patients in their primary care practice.
SUE YANOVSKI: Unfortunately, obesity is a stigmatized condition and many patients report that they have been treated with disrespect in many aspects of their lives, including healthcare. Fortunately, there are resources out there on the internet and we talk about those in our paper where doctors and other clinicians and their staff can learn how to treat their patients with obesity in a respectful and welcoming manner.

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