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Obesity Care: Taking a Longer View of Weight History

In obesity care, the longer view of a weight history is essential to understanding a person’s journey of health. It’s all about the trajectory of a lifetime. For example, on Reddit a person reflects on their own history:

“My current weight is the most I’ve ever weighed. At the moment I’m at 174 lbs. Before I moved to the USA a couple of years ago, I’d never been more than 140.”

This is a sensitive subject for most people, but it is one that stays with a person. It is also key for understanding clinical progress in managing the chronic disease of obesity. So now, in Archives of Endocrinology and Metabolism, Bruno Halpern and colleagues propose looking at clinical status of obesity through the lens of weight history:

“The Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having ‘reduced’ or ‘controlled’ obesity.”

The concept is relatively simple: to identify progress in managing obesity against the benchmark of a person’s highest lifetime weight.

Clinical Care in the Context of a Chronic Condition

Obesity is a complex, chronic disease. Typically over a lifetime, it is progressive in the absence of clinical and self care. Acute situations can lead to episodes of weight gain. Obesity care and changes in lifestyle can bring weight loss. Thus, for obesity care it is essential to understand a person’s weight history. Halpern explains:

“I commonly receive patients who have lost a significant amount of weight in the past. But as they still are in the range of obesity, they believe they need to lose more and more weight. Health professionals may urge them to do so. But they get very frustrated as they struggle even to maintain their state of reduced weight. Using this classification of a reduced or controlled state of obesity can help both patients and health professionals understand appropriate goals. For many patients with reduced obesity, weight maintenance might be the appropriate target.”

Highly Individual Histories and Goals

Two years ago, the Clinical Committee of the Obesity Society (TOS) concluded that weight history is an essential component of a medical history for a person with obesity. They further concluded that life stage, duration of exposure to obesity, maximum BMI, and trajectory modeling are also important. In their perspective, they write:

“Eliciting a weight history can provide clinically important information to aid in treatment decision-making. This view is consistent with the life course perspective of obesity and the aim of patient-centered care, one of six domains of healthcare quality.”

Thus, the new proposal from Halpern et al is entirely consistent with emerging standards for good obesity care. If a patient and provider want to know where they are going with obesity care, they must understand where they’ve been.

Click here for the new Halpern paper and here for the TOS paper on weight histories. For perspective on the implications in primary care, click here.

River View with a Boat, painting by Piet Mondrian / WikiArt

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April 22, 2022

6 Responses to “Obesity Care: Taking a Longer View of Weight History”

  1. April 22, 2022 at 12:01 pm, John DiTraglia said:

    Greater than 10% weight loss from any size or shape should be considered a scary history.

    • April 22, 2022 at 1:10 pm, Ted said:

      I don’t really agree. People who have bariatric surgery typically lose 20-30 percent of total body weight, live longer, enjoy a better quality of life, and often put their complications of obesity into remission. Likewise people who take semaglutide for obesity typically lose about 15 percent of total body weight and improve their health and quality of life. With that said, for someone with a history of losing more than 10 percent of their body weight, forward looking goals might appropriately focus on weight maintenance. It’s also worth noting that personal goals related to health and weight will vary from person to person.

  2. April 22, 2022 at 1:46 pm, John DiTraglia said:

    whoops. I meant people who lost weight the old fashioned way – not gastric bypass or semaglutide.

    • April 23, 2022 at 3:16 am, Ted said:

      I see what you mean. Unexplained or excessive weight loss can signal a problem.

  3. April 22, 2022 at 2:15 pm, Arya Sharma said:

    Useful concept – blogged about the clinical importance of recognizing the post-weight loss state back in 2018. https://www.drsharma.ca/the-three-clinical-faces-of-obesity

    • April 23, 2022 at 3:17 am, Ted said:

      Yes! You are always ahead of the curve, Arya.