AHA 2017: DCRI researchers highlight opportunities for significant improvement in obesity care at a health system level

November 14, 2017 – A high prevalence of obesity and under-utilization of pharmacologic therapy necessitate substantial improvement in obesity care at a health system level, says study.

A recent retrospective analysis by DCRI researchers presented at the annual American Heart Association conference in Anaheim, California, aimed to explore whether enough was being done in the Duke Health system to address the obesity epidemic and to determine areas for improvement.

Obesity in the United States has been increasingly cited as a major health concern in recent decades and with the epidemic growing at a fast pace, the country now contains one of the highest percentage of obese people in the world.

“There are as many reasons for obesity as there are obese individuals,” said the DCRI’s Neha Pagidipati, MD, first author of the study. “Some people gain weight because they eat out all the time and do not have time to cook, others eat to relieve stress or anxiety, some have a food addiction, and for others, it runs in the family,” she said.

Neha PagidipatiThe study population included 173,462 adult patients in the Duke Primary Care system who had at least two body-mass index (BMI) measurements between 2013 and 2016 and their baseline characteristics and weight loss medication use were assessed by BMI category. BMI is the tool most commonly used to estimate and screen for overweight and obesity in adults and children. For most people, BMI is related to the amount of fat in their bodies, which can raise the risk of many health problems.

“We found not only that the majority of our primary care population is either overweight or obese, but that almost none of them are on pharmacotherapy to reduce weight,” said Pagidipati. “Over two years of follow-up, regardless of their initial BMI, their essentially weight stayed the same, which means we have much to do in order to improve obesity management in our health system,” she said.

The study found that out of the total patient population, 32 percent was overweight and 39 percent obese. Obese patients were more likely than normal weight patients to be non-white, hypertensive, hyperlipidemic, diabetic, and with history of coronary artery disease or heart failure. Moreover, among obese patients, less than 10 percent were on any weight loss medication.

According to Pagidipati, most healthcare providers are hesitant to prescribe weight loss medications, in part because they are uncomfortable with managing the proper dosage of these medications. Many of the medications are complex and have a hefty side effect profile. In her opinion, each health system needs to have a group of clinicians who are comfortable with prescribing these medications and managing patients who are on them. There is also lack of surety on the part of providers on when the best time to initiate these medications is and how long should they let patients try to lose weight on their own before they become more aggressive with medications or surgery.

“Our task as healthcare providers is to develop a suite of interventions that targets the most common reasons behind obesity, and to test different ways to implement them,” said Pagidipati. “It is also necessary for patients who are trying to lose weight to have frequent touch points with their providers, both for support and for motivation. To achieve this goal, a multidisciplinary team of a clinician, case manager/health coach, nutritionist, and behavioral change specialist is integral,” she said.

Given this new information, the researchers stress on the need to rapidly test different interventions aimed at both providers and patients to affect weight loss. It is widely known that obese patients, overall, need to lose weight for the sake of their future wellbeing. The next step, according to researchers, is figuring out how to achieve this on a health system level.

In addition to Pagidipati, other researchers included Matthew Phelan, Karen Chiswell and Eric D. Peterson.