Primary care providers' perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study

Obesity management in primary care: A joint clinical perspective and expert review from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) - 2025

Background

This collaboration from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) examines obesity management from a primary care perspective.

Methods

This joint perspective is based upon scientific evidence, clinical experience of the authors, and peer review by the OMA and ACOFP leadership. The goal is to identify and answer sentinel questions about obesity management from a primary care perspective, utilizing evidence-based publications, and guided by expert clinical experience.

Results

Obesity is a disease that contributes to both biomechanical complications and the most common cardiometabolic abnormalities encountered in primary care. Barriers that impede optimal care of patients with obesity in primary care include failure to recognize obesity as a disease, lack of accurate diagnosis, insufficient access to obesity treatment resources, inadequate training, insufficient time, lack of adequate reimbursement and the adverse impact of bias, stigma, and discrimination.

Conclusions

Family physicians are often the first line of treatment in the healthcare setting. This affords early intervention opportunities to prevent and/or treat overweight and/or obesity. Patient care is enhanced when primary care clinicians recognize the risks and benefits of anti-obesity medications and bariatric procedures, as well as long-term follow-up. Practical tools regarding the 4 pillars of nutrition therapy, physical activity, behavior modification, and medical interventions (anti-obesity medications and bariatric surgery) may assist primary care clinicians improve the health and lives of patients living with obesity.

Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram

The medical needs of obesity have been underrecognized, though it has posed long-term and enormous challenges to global health. Correspondingly, clinical services for obesity are still uncommon and in their infancy across health systems. It is meaningful to sort out the implementation of such clinical services involving a multiplicity of factors to identify measures for service development, scaling-up and optimization. This study aims to generate a comprehensive understanding of key variables and factors in the utilization and delivery of clinical services for adult patients with obesity and their dynamic patterns and to explore viable options for improved implementation of such services in health systems. We conducted a scoping review of published articles in the database from the lens of system dynamics through causal loop diagramming. Based on the data obtained from the review, we employed the causal loop diagramming as a tool to capture the variables in the implementation of clinical obesity services and their causal relationships. Twenty-one studies were finally included in the review. Based on the evidence consolidated through the review, we developed a causal loop diagram containing 19 causal variables and 38 causal arrows in single directions centered around the service utilization and delivery in the clinical obesity service. The feedback loops revealed potential activation points to intervene to facilitate the service implementation, such as, promotion of obesity as a disease with medical needs and available clinical services, provision of obesity-specific medical education and training opportunities, and prioritization of obesity-specific procedures in clinical protocols. The possible intervention points identified through the causal loop analysis can facilitate the development, implementation, and optimization of clinical obesity services in health systems.

Patient and Cardiologist Perspectives on the Treatment of Patients With Concomitant ASCVD and Obesity

Atherosclerotic cardiovascular disease (ASCVD) and obesity pose challenges to patients, healthcare professionals (HCPs), and health systems. The aim of this study was to understand the journey of patients with ASCVD and obesity, their caregivers, and managing HCPs to optimize treatment outcomes. Patients with ASCVD and body mass index ≥ 27 kg/m2 (N = 61), their caregivers (N = 12), and HCPs (N = 24) were given an online survey and participated in 1:1 interviews. Cardiology HCPs (N = 120) were given a quantitative online survey. Despite the presence of risk factors, patients described little communication or urgency from their HCPs regarding the link between obesity and cardiovascular health prior to an ASCVD event. Cardiology HCPs ranked obesity as only the fourth most important parameter to monitor pre- and post-ASCVD event but were hesitant to prescribe antiobesity medications pre- and post-ASCVD despite new treatment options. In fact, only 12% recommended medication for weight management. Comprehensive HCP training on weight management and medication options as well as training on strategies to communicate these options to patients and involve them in their own treatment decisions may improve patient experiences and lead to improved health outcomes in patients with obesity and ASCVD.

Unifying Efforts to Empower Equitable Obesity Care: Synopsis of an American College of Physicians and Council of Subspecialty Societies Summit

Obesity is a leading cause of morbidity and mortality with health consequences that crosscut most medical specialties. Despite the emergence of effective and promising new therapies, many impediments to comprehensive obesity care remain. As part of their commitment to improving obesity care, the American College of Physicians (ACP) and its Council of Subspecialty Societies (CSS) held a summit on 24 October 2023 to identify barriers to and opportunities for collaborative action in the domains of physician education, health care policy and care delivery, and addressing weight bias. This report summarizes the summit proceedings and provides a postsummit synthesis from ACP and CSS. Key themes were centered on knowledge, advocacy, action, and compassion, including the need for culture change, paradigm shifts, and stakeholder engagement and collaboration; a focus on empowerment of both clinicians and patients; the importance of knowing patients as people to help address social determinants of health; the need to address learned helplessness; and the importance of embracing artificial intelligence and technology as disruptive innovations. Recommendations for next steps for collaborative action include leveraging and improving already available educational and clinical resources, developing obesity education and care standards that incorporate patients' perspectives and address social determinants of health, developing community and public-private partnerships to improve access and public awareness, and coordinating messaging and policy advocacy efforts that align with mitigating the longstanding obesity epidemic.

The Landscape of Obesity Education Worldwide - Are We Doing Enough? Scoping Review of Content of Obesity Educational Interventions in Medical Schools and Residency Programs

No study appraised the curricular content of published obesity education interventions (OEI) delivered to medical students, residents, or fellows. This scoping review identified and described the curricular content of published OEI, examined the specific obesity-related domains addressed, and proposed potential directions for future intervention development. We searched PubMed and Web of Science databases. Original articles on OEI delivered to medical students, residents, or fellows were included. Data extraction was guided by the Obesity Medicine Education Collaborative's framework and the Accreditation Council for Graduate Medical Education-International (ACGME-I) competencies framework. The curricular content of OEI was categorized and visually mapped to identify trends and gaps. A total of 490 studies were identified, and 60 were included. Conceptually, twelve obesity domains emerged: epidemiology, health policy, prevention; basic sciences; nutrition; physical activity; behavioral aspects; counseling; pharmacotherapy; metabolic/bariatric surgery (MBS); weight stigma; ethics/professionalism; health literacy; and practice guidelines. Geographically, most OEI (88.3%) were implemented in North America. Three-quarters of OEI were for medical students, less OEI were for residents, and none for fellows. Content-wise, the OEI for medical students and for residents exhibited strikingly limited coverage of all obesity domains, although those for residency programs had more limited coverage than those for medical schools. Across medical schools, the most common domains addressed were basic sciences (48.3%), counseling, and nutrition (45% each); the least included were pharmacotherapy (13.3%), ethics/professionalism (3.3%), and health literacy (1.6%). For residency programs, the most common domains addressed were basic sciences and counseling (21.6% for each); the least were pharmacotherapy and MBS (6.6% each), weight stigma (5%), ethics/professionalism (3.3%) and health literacy (1.6%). Many critical domains of obesity remain inadequately addressed in the education provided in medical schools and residency programs. Future OEI should incorporate these to equip future physicians with knowledge, skills, and attitudes to care for patients with obesity.

Consolidating International Care Models and Clinical Services for Adult Obesity

PURPOSE OF REVIEW

This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care.

RECENT FINDINGS

The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.

Older Adults' Views on Insurance Coverage for Weight Management Medications

Importance

Medicare and many commercial insurers do not cover US Food and Drug Administration-approved weight management medications, such as incretin mimetics (semaglutide, tirzepatide, and liraglutide), bupropion-naltrexone, and phentermine-topiramate).

Objectives

To assess older adults' interest in weight management medications and associated characteristics and to understand their perceptions about insurance coverage of weight management medications.

Design, Setting, and Participants

This survey study used cross-sectional data from a nationally representative sample of US adults ages 50 to 80 years from the July 2023 National Poll on Healthy Aging. Data were analyzed from August to November 2023.

Main Outcomes and Measures

Outcomes of interest were estimates of interest in taking weight management medication and perceptions about coverage for US Food and Drug Administration-approved weight management medications by insurers, including Medicare.

Results

Among 2657 respondents, 60.3% (95% CI, 56.7%-63.8%) were ages 50 to 64 years, 52.2% (95% CI, 49.8%-54.5%) were female, and 10.6% (95% CI, 9.3%-12.0%) were non-Hispanic Black, 11.4% (95% CI, 10.4%-12.6%) were Hispanic, and 70.3% (95% CI, 68.2%-72.4%) were non-Hispanic White. Overall, 35.1% (95% CI, 31.9%-38.4%) of participants were interested in using weight management medications, including 59.1% (95% CI, 53.4%-64.5%) of individuals with body mass index (BMI) of 30 or greater. Interest was most robustly associated with having used these medications in the past (adjusted odds ratio, 7.57 [95% CI, 4.41-13.02]) and BMI of 30 or greater (adjusted odds ratio, 5.04 [95% CI, 3.48-7.30]). Most participants (of any BMI) agreed that health insurance should cover weight management medications (2176 of 2625 respondents [83.2%]). When asked whether Medicare should cover such medications, most still favored coverage (2097 of 2616 respondents [75.7%]), but fewer approved of paying more for a Medicare premium to ensure coverage (829 of 2604 respondents [30.2%]).

Conclusions and Relevance

In this survey study of older US adults, most participants agreed that Medicare should cover weight management medications and more than half of those with BMI of 30 or greater were interested in using them. These results should inform decisions to include weight management medications in the Medicare and commercial insurance programs, as well as utilization policies to control health care costs.

Electronic health records tools for treating obesity among adult patients in primary care: A scoping review

Background

Electronic health record (EHR)-based tools, such as clinical decision support systems (CDSS), support practitioners to promote evidence-based care, which may include obesity treatment. Our objective was to identify obesity-focused CDSS for adult patients in primary care settings to describe their designs, associated primary care practitioner (PCP) training, and outcomes among PCPs and patients.

Methods

We conducted a scoping review to identify and map available evidence using a search strategy for citations in MEDLINE from February 2009 to June 2024. We extracted information from included studies that described EHR-based CDSS tools designed to support obesity care (e.g., clinical decision support, counseling) for adult patients in primary care settings. We mapped common tool features to support weight management and synthesized key lessons learned during implementation of these tools.

Results

Of the 445 citations identified in our search, we included 13 citations reporting on 8 studies. The most common features across EHR-based CDSS tools were 1) identifying overweight or obesity using BMI (88 %) and 2) suggesting treatment strategies (88 %), particularly lifestyle modifications. Most studies provided limited information on the training PCPs received. Few PCPs used the CDSS with eligible patients (<20 %), describing these tools as cumbersome and lacking clinical workflow integration. Novel approaches included using CDSS during weight management-dedicated visits or for referral to obesity medicine physicians, which both showed promising early results of patients achieving weight reduction.

Conclusion

There is a growing body of evidence for obesity-focused CDSS among adult patients in the primary care setting. Our review identified three key lessons that may inform future health system implementation: 1) EHR-based CDSS tools need to be easy to use and integrate with clinical workflows; 2) PCPs need training on these tools for obesity treatment; and 3) Primary care workflow or work-scope may need to be modified to address obesity.

Comparing clinical practice habits among obesity medicine physicians by patient, physician and clinic factors

Background

While clinical practice habits vary by patient, physician and clinic factors in primary care, limited research has examined whether differences exist in obesity medicine. Our objective was to compare practice habits by such factors among obesity medicine physicians certified by the American Board of Obesity Medicine (ABOM).

Methods

We conducted secondary analyses of cross-sectional data from the 2023 ABOM Practice Analysis Validation Survey. We included three obesity medicine practice habits - prescribing anti-obesity medications (AOMs), off-label prescribing of medications for weight reduction, and obesity medicine clinical practice hours (4-20 h/week versus >20 h/week). We included patient (patient population), physician (primary medical specialty, years of obesity medicine experience) and clinic factors (practice setting, geographic catchment, accepts insurance for obesity care). We conducted bivariate analyses using Χ2 tests.

Results

Among 565 ABOM-certified physicians, 71.5 % had primary medical specialties within primary care and 9.2 % predominantly treated children/adolescents with obesity. Overall, 97.5 % prescribed AOMs and 85.1 % prescribed off-label medications for weight reduction. Fewer physicians who predominantly treated children/adolescents prescribed AOMs compared to physicians with no or limited treatment of children (88.5 % versus 98.4 % and 98.5 %, respectively; p < 0.001). Overall, 41.4 % reported practicing obesity medicine >20 h/week, which was more likely to occur as years of obesity medicine experience increased (i.e., 21.9 ​% among physicians with 1-2 years of experience versus 58.5 ​% with 10+ years; p ​< ​0.001). No significant differences in practice habits occurred by primary medical specialty, practice setting, geographic catchment, or accepting insurance.

Conclusion

Our findings may suggest that ABOM-certified physicians have consistent obesity medication prescribing practices regardless of physician or clinic factors, which may be particularly important to patients seeking pharmacologic treatment. Most ABOM-certified physicians who predominantly treat children/adolescents prescribe obesity medications. These current rates are relatively higher than prior findings among pediatric ABOM-certified physicians, which might help support pharmacologic access for pediatric patients.

The American Board of Obesity Medicine: A Pathway to Provision of Competent Obesity Medicine Care

Though obesity is highly prevalent in the United States, undergraduate and graduate medical education regarding obesity is insufficient. There is also clear evidence that few practicing primary care providers use evidence-based guidelines to make obesity treatment decisions. In contrast, American Board of Obesity Medicine diplomates are more likely to provide evidence-based obesity medicine care, and American Board of Obesity Medicine certification signifies that a physician is competent in the practice of obesity medicine.

Team Approach: An Interdisciplinary Framework for Weight Loss Before Total Joint Arthroplasty Surgery

» Obesity is a public health concern, with 41.9% of the US population classified as obese. Obesity increases the risk of chronic disease, type II diabetes, cardiovascular diseases, etc., leading to increased morbidity and mortality. Obesity has been identified as an independent risk factor of postoperative complications, including infection and impaired wound healing, following elective surgery. In total joint arthroplasty, it has been well elucidated that obese patients are predisposed to higher rates of postoperative complications, longer hospital stays, and increased cost of stay.» Obesity is influenced by the interplay between many societal, behavioral, and socioeconomic factors and requires a multidisciplinary approach to treatment. The patient's care team should be well versed in nutritional counseling, behavioral health counseling, medication management, and surgery to allow for a comprehensive approach.» Orthopaedic surgeons, dietitians, nutritionists, weight-loss physicians, and bariatric surgeons all play a critical role in treating this patient population. This review highlights the roles of these practitioners in developing an interdisciplinary framework to help patients with hip and knee arthritis lose weight before joint replacement surgery. Not only will this afford more patients the quality-of-life benefits that come with a hip or knee replacement but will also serve to decrease the complication rates associated with this patient cohort.» The aim of this review was to educate orthopaedic surgeons on various strategies that can be used to best optimize these patients for successful joint replacement surgery.

Trends and Disparities in Newer GLP1 Receptor Agonist Initiation among Real-World Adult Patients Eligible for Obesity Treatment

Aims

To characterize trends in the initiation of newer anti-obesity medications (AOMs) and determine factors associated with their use among obese/overweight populations.

Materials and methods

This retrospective study utilized electronic health record data from OneFlorida+ (2015-2024). Adults eligible for AOMs were included, defined as having a BMI ≥30 kg/m² or a BMI of 27-29.9 kg/m² with at least one obesity-related comorbidity. The primary outcome was the initiation of newer AOMs, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) including liraglutide, semaglutide, and tirzepatide. Trends across years were examined, and a multivariable logistic regression identified sociodemographic, clinical, and healthcare utilization factors associated with AOM initiation.

Results

Of 319,949 adults, 1.8% initiated newer AOMs. Semaglutide accounted for 77.9% of initiations, tirzepatide 19.7%, and liraglutide 17.8%. Initiation trends showed liraglutide uptake peaked at 5% in 2018 but declined afterward, while semaglutide and tirzepatide uptake increased exponentially since 2022. Odds of initiation were lower for Black (aOR (95% CI): 0.87 [0.80- 0.94]) and Hispanic (0.84 [0.78-0.91]) groups vs. Whites, and for Medicaid (0.69 [0.63-0.76]) and uninsured (0.81 [0.74-0.87]) patients vs. privately insured. Higher odds were associated with being female, middle-aged, having more outpatient visits, and visiting endocrinologists.

Conclusions

The initiation of newer AOMs among overweight and obese populations remains low, but uptake has increased exponentially since 2022. Our findings reveal significant disparities in obesity care, highlighting the importance of addressing inequities in AOM access to improve obesity outcomes.

Exploring Racial and Ethnic Differences in Utilization of Medications for Obesity Management in a Nationally Representative Survey

BACKGROUND

The burden of obesity falls disproportionately on some racial and ethnic minority groups.

OBJECTIVE

To assess for racial and ethnic differences in the utilization of obesity-management medications among clinically eligible individuals.

DESIGN

Medical Expenditure Panel Survey (2011-2016, 2018 and 2020) data and a cross-sectional study design was used to assess for racial and ethnic differences in obesity-management medication utilization. Descriptive statistics and multivariable logistic regression models were used to identify the association of race and ethnicity with obesity-management medication utilization. Adjusted models controlled for demographics, socioeconomic status, obesity class, diabetes status, number of chronic conditions, insurance status, and geographic region.

PARTICIPANTS

Adults with a BMI ≥ 30 kg/m2 and individuals with a BMI ≥ 27 kg/m2 with ≥ 1 weight-related condition.

MAIN MEASURES

The primary outcome measure was utilization of an FDA-approved medication for obesity-management during the study period. The primary independent predictor was race and ethnicity. Separate indicator variables were created for each racial and ethnic group (Non-Hispanic Asian, Non-Hispanic Black, Hispanic, and Non-Hispanic White (reference group)).

KEY RESULTS

In adjusted analyses, Asian (aOR, 0.36; 95% CI, 0.16 to 0.77; P < 0.01), Black (aOR, 0.51; 95% CI, 0.39 to 0.68; P < 0.001) and Hispanic individuals (aOR, 0.70; 95% CI, 0.49 to 0.98; P = 0.04) had significantly lower odds of utilizing obesity-management medications compared to White individuals.

CONCLUSIONS

The results of this study suggest that there are racial and ethnic disparities in the use of obesity-management medications.

Opportunities for General Internal Medicine to Promote Equity in Obesity Care

The number and complexity of obesity treatments has increased rapidly in recent years. This is driven by the approval of new anti-obesity medications (AOMs) that produce larger degrees of weight loss than previously approved AOMs. Unfortunately, access to these highly effective therapies and to integrated team-based obesity care is limited by intra-/interpersonal patient, institutional/practitioner, community, and policy factors. We contextualized these complexities and the impact of patients' social drivers of health (SDOH) by adapting the social ecological model for obesity. Without multi-level intervention, these barriers to care will deepen the existing inequities in obesity prevalence and treatment outcomes among historically underserved communities. As General Internal Medicine (GIM) physicians, we can help our patients navigate the complexities of evidence-based obesity treatments. As care team leaders, GIM physicians are well-positioned to (1) improve education for trainees and practitioners, (2) address healthcare-associated weight stigma, (3) advocate for equity in treatment accessibility, and (4) coordinate interdisciplinary teams around non-traditional models of care focused on upstream (e.g., policy changes, insurance coverage, health system culture change, medical education requirements) and downstream (e.g., evidence-based weight management didactics for trainees, using non-stigmatizing language with patients, developing interdisciplinary weight management clinics) strategies to promote optimal obesity care for all patients.

Early versus late-onset of weight struggles among patients with obesity: Data from the ACTION-IO study

Background and Aim

The prevalence of obesity is increasing and people with obesity (PwO) continue to struggle with their weight. We aimed to describe the experiences of people who struggled with their weight at an early age (EAO) or at a later age (LAO), their discussions with their healthcare practitioners (HCPs) and episodes of depression and anxiety.

Methods

We gathered information from 1,000 adults PwO, categorized them into EAO and LAO and analyzed their responses regarding weight loss attempts, discussions with their HCP, perceptions about obesity and episodes of depression/anxiety.

Results

Mean age was 36.6 years old, and 73.0% were AAO. EAO had significantly fewer weight loss attempts and had fewer interactions with their HCP. EAO reported less HCP support for weight management, were less motivated to lose weight, and experienced more episodes of anxiety/depression. Significant association between greater obesity class with longer duration of weight problems, and depression and anxiety. EAO PwOs were less likely to discuss weight problems with their HCP.

Conclusion

It is fundamental that HCPs recognize and address weight issues in PwO who are at risk of obesity in adulthood as early as adolescence. They should also take the lead in addressing these psychophysiological concerns by involving the parents in the decision-making process and facilitating shared planning. These may enhance their motivation to lose weight, boost self-confidence, and reduce the complications of obesity.

Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities

PURPOSE OF REVIEW: To analyze how social and structural determinants of health and social injustice impact the risk of obesity, its treatment and treatment outcomes, and to explore the implications for prevention and future treatment interventions. RECENT FINDINGS: Racial and ethnic minorities, such as non-Hispanic Black adults and Hispanic adults, and adults with a low socioeconomic status have a greater risk of obesity than non-Hispanic white adults and adults with a high socioeconomic status. The underlying causes of obesity disparities include obesogenic neighborhood environments, inequities in access to obesity treatment, and lack of access to affordable nutrient-dense foods. Experts have called for interventions that address the social and structural determinants of obesity disparities. Population-based interventions that focus on improving neighborhood conditions, discouraging the consumption of unhealthy foods and beverages, expanding access to obesity treatment, and ensuring equitable access to fruits and vegetables have been proven to be effective. There is a growing body of evidence that shows the relationship between social and structural determinants of health and injustice on disparities in obesity among racial and ethnic minorities and individuals with a low SES. Population-based, equity-focused interventions that address the underlying causes of obesity disparities are needed to reduce obesity disparities and improve the health outcomes of minoritized and marginalized groups.

Surveying the Knowledge and Practices of Primary Care Residents in Managing Adult Patients with Obesity

BACKGROUND

The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency.

OBJECTIVE

This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity.

DESIGN

A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period.

PARTICIPANTS

Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting.

MAIN MEASURES

The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM.

KEY RESULTS

The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p =  < 0.001), more frequently than their peers without a curriculum.

CONCLUSIONS

Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity.

Managing the new wave of weight loss medication in general practice: A qualitative study

In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.

A Primary Care-Based Weight Navigation Program

Importance

Evidence-based weight management treatments (WMTs) are underused; strategies are needed to increase WMT use and patients' weight loss.

Objective

To evaluate the association of a primary care-based weight navigation program (WNP) with WMT use and weight loss.

Design, Setting, and Participants

This cohort study comprised a retrospective evaluation of a quality improvement program conducted from October 1, 2020, to September 30, 2021. Data analysis was performed from August 2, 2022, to March 7, 2024. Adults with obesity and 1 or more weight-related condition from intervention and control sites in a large academic health system in the Midwestern US were propensity matched on sociodemographic and clinical factors.

Exposure

WNP, in which American Board of Obesity Medicine-certified primary care physicians offered weight-focused visits and guided patients' selection of preference-sensitive WMTs.

Main Outcomes and Measures

Primary outcomes were feasibility measures, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss, percentage of patients achieving 5% or more and 10% or more weight loss, referral to WMTs, and number of antiobesity medication prescriptions at 12 months.

Results

Of 264 patients, 181 (68.6%) were female and mean (SD) age was 49.5 (13.0) years; there were no significant differences in demographic characteristics between WNP patients (n = 132) and matched controls (n = 132). Of 1159 WNP-eligible patients, 219 (18.9%) were referred to the WNP and 132 (11.4%) completed a visit. In a difference-in-differences analysis, WNP patients lost 4.9 kg more than matched controls (95% CI, 2.11-7.76; P < .001), had 4.4% greater weight loss (95% CI, 2.2%-6.4%; P < .001), and were more likely to achieve 5% or more weight loss (odds ratio [OR], 2.90; 95% CI, 1.54-5.58); average marginal effects, 21.2%; 95% CI, 8.8%-33.6%) and 10% or more weight loss (OR, 7.19; 95% CI, 2.55-25.9; average marginal effects, 17.4%; 95% CI, 8.7%-26.2%). Patients in the WNP group were referred at higher rates to WMTs, including bariatric surgery (18.9% vs 9.1%; P = .02), a low-calorie meal replacement program (16.7% vs 3.8%; P < .001), and a Mediterranean-style diet and activity program (10.6% vs 1.5%; P = .002). There were no between-group differences in antiobesity medication prescribing.

Conclusions and Relevance

The findings of this cohort study suggest that WNP is feasible and associated with greater WMT use and weight loss than matched controls. The WNP warrants evaluation in a large-scale trial.

Knowledge, experiences, and perceptions relating to obesity management among primary care physicians in the Lazio Region, Italy

Background

Primary care providers (PCPs) play an essential role in obesity care as they represent the first contact for patients seeking weight loss interventions.

Objective

This study explored the knowledge, experiences, and perceptions of PCPs in the Lazio Region of Italy in the management of obesity.

Design and subjects

We conducted an anonymous survey delivered from March to July 2022 via the newsletter of Rome Provincial Order of Physicians and Dentists and at the annual meeting of the regional section of the Italian Obesity Society.

Approach

The survey consisted of 24 closed-ended questions grouped into 5 sections: sociodemographic and work information; assessment of obesity; management of obesity; connections with regional Centres for Obesity Management; attitudes towards obesity.

Key results

A total of 92 PCPs accessed the survey. Of those, 2.2% were excluded because they did not see any patients with obesity. A total of 68 PCPs (75.6%) had complete questionnaires and were included in this analysis. All participants reported asking their patients about their eating habits, lifestyle, and clinical complications at the first assessment. Body weight and blood pressure were measured by 98.5% of participants and 82% calculate body mass index (BMI), while a small proportion of PCPs analysed body composition and fat distribution. Over 80% prescribed laboratory tests and ECG. Approximately 40% of PCPs did not refer patients for nutritional counselling, and most prescribed a low-calorie diet. Sixty-three percent referred patients to an endocrinologist, 48.5% to a psychotherapist, and a minority to specialists for obesity complications. Twenty-three percent prescribed anti-obesity medications and 46.5% referred patients for bariatric surgery only in severe cases. Ninety-one percent stated that obesity is "a complex and multifactorial disease" and 7.4% considered obesity to be secondary to other conditions.

Conclusions

Despite most PCPs adopt a correct approach to manage patients with obesity, many aspects could be improved to ensure optimal and multidisciplinary management.

"Anti-obesity medications" or "medications to treat obesity" instead of "weight loss drugs" - why language matters - an official statement of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM)

Obesity is largely undertreated, in part because of the stigma surrounding the disease and its treatment. The use of the term "weight loss drugs" to refer to medications for the treatment of obesity may contribute to this stigma, leading to the idea that anyone who wants to lose weight could use them and that short-term use, only in the active weight loss phase would be enough. On the contrary, the use of terms such as "medications to treat obesity" or "anti-obesity medications" conveys the idea that the treatment is directed at the disease rather than the symptom. This joint statement by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM) intends to alert the press, healthcare professionals and scientific community about the importance of the appropriate use of language, with the aim of improving obesity care.