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Developing an effective obesity treatment plan involves understanding genetic factors, utilizing nutrition therapy, promoting physical activity, and more.
In treating the disease of obesity, a comprehensive plan emerges as a cornerstone for long-term success and improving well-being among patients. Addressing this complex disease requires considering every facet of an individual’s life. From nutrition therapy and physical activity to behavioral therapy and medical interventions, a comprehensive obesity treatment plan should include a multi-faceted approach adjusted for an individual patient’s needs. This article looks at the elements required for an impactful obesity treatment plan, emphasizing the integration of evidence-based strategies and a supportive environment.
In building an obesity treatment plan for a patient, it is important to start by understanding the relationship between genetics and biology and their impact on obesity. Genetics and biology influence multiple mechanisms of obesity: hormone regulation (with insulin, leptin, and ghrelin being especially important in hunger and satiety), variations in metabolism, fat distribution, and individual response to various treatments. Some rare cases of obesity are monogenic, resulting from a single gene mutation. Monogenic obesity should be suspected with early-onset severe obesity, hyperphagia, accompanying endocrine and development disorders, and a family history of similar symptoms. Genetic testing is now available for some of these mutations; it is often free, and the list of recognized mutations constantly expands. Specific pharmacotherapy is available for some genetic mutations, and this treatment area is expected to grow.
There are specific areas clinicians can focus on when developing an obesity treatment plan for patients. The Obesity Medicine Association recognizes four main pillars of obesity treatment: nutrition therapy, physical activity, behavioral modification, and medical interventions. Medical interventions can include prescription anti-obesity medications, weight-loss surgery, and medications to address associated conditions. Any comprehensive plan should include ongoing monitoring, support, and a plan for long-term maintenance, as overweight and obesity are chronic diseases.
Nutrition is fundamental to effective obesity treatment, which is why it is one of the OMA’s 4 pillars. While nutritional therapy alone is rarely sufficient for successful treatment, the other 3 pillars will always be more effective if a patient strives for good overall nutrition. Maintaining a good nutritional plan is vital to ongoing treatment and long-term outcomes. There is no one-size-fits-all approach. It is important to meet patients where they are and to consider cultural, religious, and lifestyle needs. Strategies often include focusing on protein intake, reducing carbohydrate load, practicing mindful eating, and keeping a food diary. Consultation with a registered dietitian or nutritionist can be part of the multi-faceted approach.
Physical activity is important for weight maintenance, lean tissue protection, cardiovascular health, and long-term appetite and hormonal regulation. The recommended types of exercise depend on a patient’s current health and physical abilities. For example, a sedentary patient may start with seated exercises, short low-impact walks, or water exercise if they can access a pool. Another patient with good physical conditioning may be ready to start high-intensity interval training on day one. Consider referral to a certified fitness professional or physical therapist. Cardiac evaluation should also be considered for a patient with cardiovascular disease if there is a question about their ability to exercise safely.
Many behavioral interventions are used in treating obesity, often starting on day one and continuing throughout treatment and maintenance. Motivational interviewing techniques help explore and overcome underlying psychological factors. Referral for cognitive behavioral therapy should be considered for patients who struggle to change their relationship with food, body image, or exercise. Especially consider referral for a patient with a suspected or previously identified eating disorder.
As mentioned earlier, motivational interviewing techniques help establish effective collaboration between healthcare clinicians and patients. Setting SMART goals (specific, measurable, achievable, relevant, time-sensitive) together is common in obesity treatment clinics. Progress can be tracked using measurements beyond the scale; body composition testing, laboratory improvements, nutritional journaling, and wearable devices are just a few of the parameters that can be followed to evaluate and celebrate the efficacy of interventions. It is vital to successfully design a plan incorporating patient preference in each treatment pillar to sustain the treatment. Healthcare professionals should also constantly evaluate and adapt the plan as a patient’s needs change throughout treatment.
Considering associated conditions within an obesity treatment plan can benefit the plan’s success. For many associated conditions, treating obesity first or concurrently is the single biggest step you can take to address those conditions. Hypertension, pre-diabetes, diabetes, hypercholesterolemia, and many other diseases are known to improve or resolve when we treat obesity directly. Obesity treatment should not be delayed whenever possible, as earlier interventions improve outcomes. For healthcare professionals beginning to develop treatment plans, the Obesity Algorithm® is designed to be a comprehensive, but not entirely inclusive, resource for understanding the disease of obesity. It is a great starting point for exploring evaluation, treatment options, and best practices; it is useful for clinicians just beginning to directly address obesity as a disease and those who are experienced in obesity treatment. The extensive references are also useful in guiding further study of specific topics.
