Experts urge to improve obesity care as latest research supports effectiveness

26 Feb 2024 --- New studies underscore the importance of obesity care, linking treatments to lowered weights and other health benefits, such as reducing inflammation and cardiometabolic risk. However, research also suggests that most people with obesity do not receive weight-related care from their usual healthcare source.

A cohort study with 146,959 participants indicates that only 7.1% of obesity patients used weight management treatments. Meanwhile, people receiving treatment, including nutrition counseling, medically supervised meal replacements, any anti-obesity medications or bariatric surgery, increased their probability of losing 5% of body weight in one year. This ranged from 23% for nutrition counseling to 93% for bariatric surgery. 

“These findings suggest that all weight management treatment options can be highly effective. The challenge is helping individual patients find a treatment that works for them and that they can stick with over time,” says Dina Hafez Griauzde, MD, a certified obesity medicine specialist and assistant professor of internal medicine at the University of Michigan Medical School, US, and senior author of the study. 

The research team hopes these findings will inspire more primary care clinics, health systems and insurers to increase the number of people with obesity who can get help accessing and choosing a treatment option. 

At the same time, Brazilian researchers tested a novel treatment strategy on 22 obese adolescents. After one year of the interdisciplinary therapy program with clinical, nutritional, psychological and exercise counseling, the participants lost weight and exhibited lower blood levels of inflammatory and cardiovascular risk mediators. 

Underuse of treatments  
The study, published in JAMA Network Open, concluded that all weight management treatment options increased the patient-level probability of achieving at least 5% weight loss. The research also includes data from years before the FDA approved GLP-1 medicines for weight loss, indicating that effective weight management does not necessarily require such medications. 

Instead, the research team urges healthcare providers to offer patients various options supported by medical evidence — nutrition counseling, medically supervised meal replacements, medication or surgery. 

Out of almost 54,000 patients with obesity, only 5,090 patients received weight management treatment. Nutrition counseling was most common, as 3,364 people had at least one appointment with a registered dietitian. Less common options included medication (1,428 patients), bariatric surgery (520) and meal replacement programs (189). 

The study’s lead author, James Henderson, Ph.D., a research scientist at the University of Michigan, highlights that the study investigated populations. During the study period, the share of people with obesity increased. Without obesity care, these people were equally likely to gain at least 5% of their baseline weight to achieve a 5% weight loss. 

“Our model shows that even doubling the currently small percentage of patients receiving weight management treatment from their care team could tip the balance at the population level, counteracting the overall trend toward weight gain,” Henderson explains. 

All weight management treatment options increased the patient-level probability of achieving at least 5% weight loss.Effective obesity care 
The research team matched the data of the patients receiving treatment from the University of Michigan medical team with data from a comparable patient with a similar body mass index who did not receive care. The researchers tracked weight changes over time. 

Receiving treatment supported by a healthcare provider was more likely to lead to weight loss than when patients tried these options independently. Without supervision, participants had a one in six chance to lose at least 5% of their body weight, which increased to one in five for people receiving nutrition counseling and one in four for anti-obesity medication. 

People stuck to medically prescribed meal replacements for a year had a one-in-two chance of losing at least 5% of their body weight. Bariatric surgery had the largest effect — patients had a nine in ten chance to lose at least 5% weight and an eight in ten chance to lose at least 10%. 

Interdisciplinary treatment   
Meanwhile, a study published in the International Journal of Environmental Research and Public Health examined an interdisciplinary treatment, which lowered inflammation and cardiovascular risk biomarkers, leading to reduced insulin resistance and lower diabetes risk, as well as lower visceral fat and a better ratio of calorie intake to expenditure. 

“We tested a new treatment model that’s not as intensive as one whose efficacy our group proved in previous studies. That’s important because less intensive means less frequent sessions, so the adolescents don’t abandon the treatment and the cost to the SUS [Sistema Único de Saúde, Brazil’s national health service] is lower,” study author Ana Raimunda Dâmaso, a professor at the Federal University of São Paulo (UNIFESP) in Brazil, told the São Paulo Research Foundation who funded the study. 

The interdisciplinary treatment helped lower weight, inflammation and cardiovascular risk biomarkers, leading to reduced insulin resistance and lower diabetes risk.The semi-intensive model included fewer sessions. For example, instead of going to the university for exercise training three times a week, participants received instructions to perform the exercises at home. Group nutritional counseling sessions took place every two weeks instead of weekly. 

This less intensive program significantly improved two hormone levels involved in inflammation — leptin and adiponectin. 

“Adolescents with severe obesity typically exhibit hyperleptinemia [overproduction of leptin] and a reduction in adiponectin secretion. This combination intensifies the pro-inflammatory state and cardiometabolic risk,” explains Dâmaso. In the study, the prevalence of hyperleptinemia fell from 77.3% to 36.4%, a more significant change than in the intense model. 

Reducing inflammation 
Earlier research by the same team determined that high leptin levels in obesity are associated with an increased risk of cardiovascular disease, eating disorders, inflammation and alternations in the neuroendocrine energy balance. These all impair people’s weight loss efforts. 

“Inflammation and cardiometabolic risk must be reduced throughout the system, lowering hyperleptinemia, cholesterol, blood pressure, insulin resistance and visceral fat, as well as other biomarkers of inflammation,” explains Dâmaso. 

The study’s first author, Deborah Cristina Landi Masquio, a researcher in UNIFESP’s obesity study group, adds that 77% of the study participants had abnormally high blood fat levels, with metabolic and pro-inflammatory alterations in progress. “We were able to reverse these and bring the energy balance back to normal.”

“A balance between leptin and adiponectin levels reduces the inflammation characteristic of obesity and the risk of various obesity-related diseases. All this is linked to a reduction in insulin resistance. At the start of the study, 81.8% of the participants had insulin resistance. By the end, the proportion had fallen to 50%,” she concludes. 

By Jolanda van Hal