Lee M. Kaplan, MD, PhD, FTOS
ObesityWeek 2024 – Oral presentation
Key messages
- Global obesity rates are still rising, and prevention efforts have been unsuccessful.
- Optimizing obesity care requires an integrated approach.
- Relief of obesity symptoms, disability, and fear is the responsibility of the healthcare system.
- Effective new drug classes can drive markets and change public policy.
Background
What do we already know about this topic?
- Despite obesity being identified as an epidemic in 1984, it has still not been eradicated.
- The global population of overweight or obesity is still increasing.
- Obesity reflects pathophysiological dysfunction within the body, and warrants treatment.
- Relief of suffering from obesity-induced symptoms, disability, and fear is the responsibility of the healthcare system.
- Healthcare organizations have five key aims: to enhance patient experience, improve provider satisfaction, reduce cost of care, advance health equity, and improve population health.1,2
Comprehensive Obesity Care
Enhancing the patient experience:
- At present, the care pathway in the USA is determined by the patient’s choice of entry point – for example, if they visit a nutritionist or a surgeon, they will get a very different approach.
- The patient experience can be enhanced by delivering comprehensive obesity centers – where care can be targeted and patient-focused in order to optimize outcomes.
- In a comprehensive care center, the patient chooses the care pathway from all evidence-based options, based on expert guidance.
- The center should be able to provide medical evaluation, a range of lifestyle/pharmacological therapies, as well as metabolic surgery, and nutritional and psychological support.
Improving provider satisfaction:
- The classic activities of a physician are to establish diagnosis, prescribe, and support the patient through that treatment; it does not include intensive counseling.
- In obesity, diagnosis requires no specialist skills, treatment has traditionally been limited, and specialists are rare. Additionally, provider bias often interferes with support.
- Comprehensive centers in other disease areas have shown that workers experience higher job satisfaction in this environment.
- Activities are more directly aligned with career goals, and there is a greater likelihood of clinical success.
Reducing the cost of care:
- Comprehensive centers reduce duplicated efforts.
- Costs can be reduced with standardized treatment algorithms and streamlined data collection.
- Strategies for access should be based on the patient’s clinical need and treatment value, and not according to their personal resources.
Advancing health equity:
- A common strategy to drive greater equity is to increase overall access.
- This is not possible in obesity due to the significant patient numbers, so there is a need to increase equity first.
- Measuring and optimizing clinical and economic benefits will allow equitable care to be scaled up.
- More equitable strategies may be providing care depending on the degree of obesity or overall clinical severity, or likelihood of clinical improvement with treatment.
- Priority should be given to obesity that interferes with effective care of another disease.
Improving population health:
- There is a need for shared understanding of obesity across treating disciplines.
- More comparable data are needed about different modalities of treatment.
- Clinical practice guidelines should reflect the strongest and most reliable evidence.
- Engagement of primary-care providers is critical, with guidelines for referral to obesity specialists.
Conclusions
- There is a default reluctance to treat obesity, and a lack of prescriptive guidelines.
- Obesity should be treated as any other chronic disease, using rational strategies with demonstrated effectiveness and predictive models.
- The future of obesity care starts with an engaged primary-care provider.
- There is a need for comprehensive obesity care centers to bring specialists under one roof.
- Effective new drug classes can drive markets and change public policy.
Source: Kaplan L.. Achieving the Quintuple Aims of Care in Obesity Treatment Presented at ObesityWeek® 2024.
The information and data provided are for informational purposes only. The author(s) of the original presentation had no involvement in the creation of this content.
Resources
- Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27(3):759–69.
- Nundy S, Cooper LA, Mate KS. The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity. JAMA 2022;327(6):521–22.
