Saturday 19th May 2018

Tackling Obesity Together

Points that healthcare professionals should keep in mind

Obesity involves more than the body!

  • infographic_19_750pxThe medical profession has knowledge of disease and treatment, while the patient has the experience of living with the disease.
  • A meaningful approach to the treatment of obesity should involve establishing a collaboration based on trust between caregiver and patient.

Obesity is a disease, not a lifestyle choice.

  • Causes of obesity range from genetic [1] and endocrine [2] conditions, to environmental factors [3] such as stress, diet and increasingly sedentary working patterns.
  • Treating obesity a chronic disease can result in significant cost savings to healthcare systems.
  • Obesity has been estimated to cost the European Union €70 billion annually through healthcare costs and lost productivity. [4]
  • The European Association for the Study of Obesity (EASO) found direct obesity-related costs ranging from 1.5–4.6% of health expenditure in France to around 7% in Spain. [5]

Obesity is the gateway to many other diseases, including most NCDs (Non Communicable Diseases).

  • Obesity plays a central role in a person’s development of a number of risk factors and chronic diseases including type 2 diabetes, cardiovascular diseases and certain cancers. [6]
  • Overweight and obesity are responsible for about 80% of cases of type 2 diabetes, 35% of ischaemic heart disease and 55% of hypertensive disease among adults in the European region [7]
  • The risk of developing more than one of these comorbidities greatly increases when body weight is elevated (BMI over 35 kg/m2) [8]

infographic_15_750pxTraining of healthcare providers is important to treat obesity needs to address bias, as well as behaviour change strategies, and the ability to work collaboratively with inter-professional teams.

  • According to an article in the Lancet weight bias by healthcare professionals can impair the quality of healthcare delivery to patients. Healthcare providers spend less time in appointments, provide less education about health, and are more reluctant to do some screening tests in patients with obesity. Furthermore, physicians report less respect for their patients with obesity, perceive them as less adherent to medications, express less desire to help their patients, and report that treating obesity is more annoying and a greater waste of their time than is the treatment of their thinner healthier. [9]
  • In the UK, the training of healthcare professionals to prevent and treat people who are overweight or with obesity was addressed and widely endorsed in a 2010 report prepared by the Royal College of Physicians. The report emphasised the need for all healthcare professionals to identify those at risk of obesity and to manage patients with obesity. It emphasised horizontal integration across disciplines and provided a framework covering both generalist and specialist level competencies, with specific skills for managing adults and children with obesity. [10]
  • The European Association for the Study of Obesity (EASO) has an Education Portal that is a resource for experts in the field of obesity treatment and for HCPs working in the area. The portal contains teaching materials including standard slide decks, webcasts and standardised course content. As this is intended for professionals it requires access permission which can be obtained by emailing [email protected]

Reducing stigmatisation and discrimination can improve recovery rates [11]

  • It is important to create a supportive healthcare environment to ensure the successful treatment of people with obesity. [12]
  • With the right support, people living with obesity can make real progress

Policy and environmental changes alone are unlikely to result in substantial weight loss in patients with severe obesity

  • Whilst we must continue to advocate for effective public policy, education and awareness to prevent obesity, we must provide better care and treatment for those who are already living with obesity.

There is a need for greater medical specialism in obesity

There is a recognised need for multi-disciplinary weight management programmes supported by specialists including psychologists, special nurses, dieticians and exercise physiologists. [13]

All healthcare professionals and providers should keep themselves up to date with the latest prevention and treatment methods for obesity.

For more on guidance and resources on obesity please refer to the EASO guidance pages.

For more information please also see the EASO Milan Declaration: A call to Action on Obesity

Points that pharmacists should keep in mind

Pharmacists have an important role to play, advising patients on weight loss options and encouraging them to seek advice from their healthcare provider.

  • infographic_20_750pxPharmacies are often the first point of information for people with overweight or obesity.
  • Pharmacists have an opportunity to talk directly to patients with obesity who have not yet consulted their doctor. Therefore there is a greater opportunity to counsel them, particularly when it affects other conditions for which they are seeking medication.
  • Counselling patients on their weight and how to manage it encourages more people with obesity to attempt weight loss. [14]

For more information please also see the EASO Milan Declaration: A call to Action on Obesity

Points that healthcare system reimbursers and insurers should keep in mind

Treating obesity, in combination with prevention programmes, can improve public health and public health services.

  • While acknowledging the importance of prevention in tackling the obesity epidemic, it is also important to provide available and effective treatment for the millions of Europeans who already have obesity.

Obesity is a gateway to many other diseases.

Since obesity is a gateway to many other diseases, if obesity is managed appropriately it will close the gate to comorbidities including type 2 diabetes, cardiovascular diseases and certain cancers. [15] The diseases attributable to obesity are often reduced or even completely disappear when obesity is treated. [16]

The burden that obesity-related comorbidities place on healthcare systems is substantial.

  • People with obesity increase indirect medical costs by up to 30% and direct medical costs by up to 39%, compared to people of normal weight. [17]
  • Funding treatment for people with obesity does not only benefit them but European taxpayers, healthcare providers and insurance reimbursers.

Treatment of obesity requires long term care.

  • Long-term support of patients having obesity ensures higher success rates and encourages them to continue living a healthy lifestyle [18]

Reimbursing aftercare increases success rates of treatment

  • Long-term support of people with obesity results in higher success rates and encourages them to continue living a healthy lifestyle [19]

For more information please also see the EASO Milan Declaration: A call to Action on Obesity

Resources

[1] Genetics of obesity and the prediction of risk for health, Andrew J. Walley, Alexandra I.F. Blakemore and Philippe Froguel, 2006

[2] Obesity and endocrine disease, Kokkoris P, Pi-Sunyer FX. 2003

[3] http://www.who.int/mediacentre/factsheets/fs311/en/

[4] The University of Reading (UK), Research and Enterprise Services; European Commission Eatwell Report: http://cordis.europa.eu/result/rcn/53206_en.html

[5] EASO, Obesity perception policy

[6] http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_part2.pdf. Page 17

[7] World Health Organisation. The challenges of obesity in the WHO region and the strategies for response, 2007

[8] Ikramuddin, S. Roux-en-y Gastric Bypass vs Intensive Medical Management for the control of type 2 diabetes, hypertension and hyperlipidemia: The Diabetes Survey Study Randominzed clinical trial. JAMA 2013 http://jama.jamanetwork.com/article.aspx?articleid=1693889

[9] Management of obesity: improvement of health-care training and systems for prevention and care

Dietz, William H et al. The Lancet , Volume 385 , Issue 9986 , 2521 – 2533 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61748-7/abstract

[10] Royal College of Physicians. The training of health professionals for the prevention and treatment of obesity. Report prepared for Foresight by the Royal College of Physicians. 2010. https://www.rcplondon.ac.uk/news/rcp-report-concludes-all-health-professionals-need-obesity-training

[11] The Obesity Society: http://www.obesity.org/resources/facts-about-obesity/bias-stigmatization

[12] The Obesity Society: http://www.obesity.org/resources/facts-about-obesity/bias-stigmatization

[13] European Association for the study of Obesity. An EASO position statement on multidisciplinary obesity management in adults. 2014 http://easo.org/wp-content/uploads/2014/03/Multidisciplinary-Obesity-Management-in-Adults.pdf

[14] Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro J: Physician weight loss advice and patient weight loss behavior change: A literature review and meta-analysis of survey data http://www.ncbi.nlm.nih.gov/pubmed/22450855

[15] Frühbeck G, Toplak H, Woodward E, Yumuk V, Maislos M, Oppert JM: Obesity: the gateway to ill health – an

EASO position statement on a rising public health, clinical and scientific challenge in Europe. Obes Facts 2013;

6:117–120. http://easo.org/wp-content/uploads/2014/03/Multidisciplinary-Obesity-Management-in-Adults.pdf

[16] European Society of Endocrinology. “Losing weight when obese can prevent or cure diabetes, whatever the initial BMI, study suggests.” ScienceDaily. ScienceDaily, 6 May 2012 https://www.sciencedaily.com/releases/2012/05/120506160149.htm

[17] The Economic Impact of Obesity in the United States: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047996/

[18] Why Aftercare is Not Optional for Long-Term Success

[19] Obesity Action Coalition, Why Aftercare is Not Optional for Long-Term Success http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/why-aftercare-is-not-optional-for-long-term-success