• Obesity medicine

    Obesity medicine

    • Obesity medicine is a field of medicine dedicated to the comprehensive treatment of patients with obesity. Obesity medicine takes into account the multi-factorial etiology of obesity in which behavior, development, environment, epigenetic, genetic, nutrition, physiology, and psychosocial contributors play a role. As time progresses, we become more knowledgeable about the complexity of obesity, and we have ascertained that there is a certain skill set and knowledge base that is required to treat this patient population. Clinicians in the field should understand how a myriad of factors contribute to obesity including: gut microbiota diversity, regulation of food intake and energy balance through enteroendocrine and neuroregulation, and adipokine physiology. Obesity medicine physicians should be skilled in identifying factors which have contributed to obesity and know how to employ methods (behavior modification, pharmacotherapy, and surgery) to treat obesity. No person with obesity is alike, and it is important to approach each patient as an individual to determine which factors contributed to their obesity in order to effectively treat each patient.

      Some physicians do not feel as though obesity medicine should be its own sub-specialty. Rather, they feel as though obesity, as a complex disease process, should be treated by endocrinologists or physicians who have acquired additional training in the field of nutrition.

      In June 2013, the American Medical Association (AMA) adopted policy that recognizes obesity as a chronic disease, a disease process which requires a range of medical interventions to prevent and treat. While professionals from different professions (US senators, congressmen and congresswomen, physicians, and medical students) applauded this decision, others were not so eager to categorize obesity as a disease. Since the initial acknowledgement of obesity as a disease by the AMA, there has been an ongoing debate about the topic.

      In November 2013, the American College of Cardiology (ACC), the American Heart Association, and the The Obesity Society (TOS), developed the 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults.

      • Annual assessment of weight status of all children
      • Children and adolescent 2 to 18 years of age with BMI of ≥95th percentile for age and gender or BMI of >30 (whichever is smaller) should be considered obese and individuals with BMI of ≥85th percentile should be considered overweight
      • Qualitative assessment of dietary patterns
      • Physical activity assessment
      • Thorough physical exam
      • Documentation of family history of obesity related co-morbidities
      • Appropriate laboratory testing for those who meet criteria for overweight or obesity
      • Address weight management and lifestyle management annually
      • Prevent children and adolescents in normal body mass index (BMI) range (5th to 84th percentile) from weight gain
      • Children with overweight and obesity should be treated in a staged manner (taking into account their degree of risks)
      • Patient Level Interventions- 1) Limit consumption of sugar-sweetened beverages, portion size, and screen time to < 2 hours/daily, and 2) Encourage breakfast daily, intake of fruits and vegetables, and family meals
      • Practice and Community Level Interventions- 1) Federal and local government support to improve built environment, and 2) Encourage parents or caregivers to be good role models for children and adolescents
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    • Obesity medicine