Please Wait

Delayed Versus Early Treatment for Obesity

Healthcare systems all around the world treat obesity weirdly. On one hand, providers tell us it’s a serious condition. It has many complications. On the other hand, health systems routinely delay treatment. They let complications pile up and obesity becomes almost untreatable. This is an obvious mistake. And once again, a new study tells us that this makes absolutely no sense. Treatment delayed is health denied.

A Retrospective Cohort

Rojin Safavi and colleagues published their study in Obesity Science and Practice. They analyzed a retrospective cohort of 172 patients in a 72-week obesity treatment program. They compared people who receive anti-obesity medicines early in the program to patients who received them later or not at all. The early group received medication within the first two months of starting treatment. Everyone else who received anti-obesity meds was in the late treatment group.

Folks who got medication early lost more weight on average. In addition, a higher percentage lost more than 15 percent of their starting weight. And the difference was pretty big – 72 versus 43 percent.

Of course, this study is not an RCT. It’s observational. That’s a major weakness because the people who opted for anti-obesity meds might be different from the others in ways that the researchers didn’t measure. But it does reflect real world experiences.

Using Effective Treatment as a Last Resort

The unfortunate truth is this. Health systems currently resist providing real, effective obesity care until it becomes a last resort. This is especially true for bariatric surgery. Kids living with severe obesity from an early age are pretty much on their own. They become teens with severe obesity who need bariatric surgery. But bias against that option it hard for teens to choose surgery. In addition, payers add to the problem by putting unnecessary barriers in the way of getting surgery.  Many will delay the surgery they need until they become adults.

A recent study in the New England Journal of Medicine shows that this is wrong. Delayed surgery is less likely to bring diabetes and hypertension under control. Significantly less likely.

Getting Serious and Acting Seriously

If we were taking obesity seriously, it would make no sense to delay treatment. It’s a chronic disease that progresses to cause many complications if not treated. Treatment prevents those complications. The only hard part about this is getting past biases about this disease and the people who have it. We would never delay treatment for cancer, or diabetes, or heart disease.

When we get serious about obesity, we’ll act seriously and provide better care for people living with it.

Click here for the Safavi study and here for further perspective on the implications of delayed treatment.

Please Wait, photograph © Kiyok / Wikimedia Commons

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September 2, 2019