Provider attitudes and practice patterns of obesity management with pharmacotherapy

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The prevalence of obesity in the United States is high. In 2011–2012, 35%, one third or 78.4 million American adults are obese (Centers for Disease Control and Prevention [CDC], 2016c). Although there have been no significant changes in obesity prevalence since 2003–2004, the number of those living with obesity remains at an all‐time high. Alarmingly, the prevalence of extreme obesity (body mass index [BMI] ≥40 kg/m2) increased by 70% between 2000 and 2010 (Sturm & Hattori, 2013).
The direct and indirect costs attributed to obesity in the United States are staggering. While direct medical costs may include prevention, diagnostic, and treatment services associated with obesity and obesity‐related diseases, indirect medical costs may include premature mortality, higher disability insurance premiums, and productivity loss because of obesity (Hammond & Levine, 2010). Overall, the annual medical burden of obesity has risen to 9.1% of all medical spending with approximately $147–$210 billion per year spent on obesity‐related healthcare costs (Trust for America's Health & Robert Wood Johnson Foundation, 2017).
Obesity is a significant health concern. The disease substantially increases the risk for morbidity and mortality because of the wide range of associated comorbidities. According to CDC (2016a), obesity‐related conditions comprise some of the leading causes of preventable death, including cardiovascular disease, stroke, type 2 diabetes, and certain types of cancer. Overall, as BMI rises, the risk for multimorbidity (co‐occurrence of multiple long‐term diseases) increases in both men and women. The prevalence of multimorbidity in men and women with normal weight is 23% and 28%, respectively, rising to 44% in men and 51% in women with extreme obesity (Booth, Prevost, & Gulliford, 2014). Weight loss of 5%–10% of total baseline body weight has been shown to decrease cardiovascular disease risk factors, including lowering blood pressure and blood cholesterol, as well as preventing or delaying the development of type 2 diabetes by reducing blood sugars (CDC, 2016b).
Despite the concerning obesity epidemic, appropriate and consistent management of obese individuals in primary care settings remains varied (Bleich, Pickett‐Blakely, & Cooper, 2011; Shiffman et al., 2009). Current clinical guidelines from the U.S. Preventive Services Task Force recommend that all adult patients be screened for obesity and individuals with BMI ≥30kg/m2 should be offered or referred to intensive, multicomponent behavioral interventions (Moyer, 2012). Regardless of these recommendations, several cross‐sectional studies have shown that not only are obese individuals not being consistently diagnosed, weight loss counseling by primary care providers (PCPs) is also infrequent, inconsistent, and suboptimal (Bleich et al., 2011, Shiffman et al., 2009; Smith et al., 2011). Weight loss counseling strategies may include discussion of obesity diagnosis and its associated risk factors, advice regarding lifestyle interventions such as diet and/or exercise, or recommendations for pharmacotherapy or bariatric surgery. When weight loss counseling is incorporated into clinical practice, studies have found that lifestyle interventions are the foundation of PCPs' recommendations. Although pharmacotherapy and bariatric surgery are available and effective weight loss interventions, they are often not included or rarely recommended to individuals with obesity (Ferrante, Piasecki, Ohman‐Strickland, & Crabtree, 2009; Shiffman et al., 2009).
Lifestyle interventions alone are not particularly successful in providing long‐term weight maintenance because of behavioral and environmental pressures as well as biological mechanisms induced by weight loss (Booth, Prevost, Wright, & Gulliford, 2014; Johannsen et al., 2012). Although many individuals are able to lose weight initially with diet and exercise, more than one third of weight lost is regained within year 1 (MacLean, Bergouignan, Cornier, & Jackman, 2011).

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