Reflection in a Soap Bubble

Bringing Serious Obesity Care Out of Its Little Bubble

“This is a dream come true.” In her opening presentation yesterday to a diverse group of experts in cardiology, endocrinology, and healthcare, the renowned Donna Ryan was marveling at the broad interest surfacing in serious obesity care – reaching far beyond the limited bubble where it stayed for decades. The American College of Cardiology assembled this group at its headquarters.

Cardiologist Steven Nissan spoke with bravado, saying, “We need to own this space.” He reflected on a frustrating history of efforts to treat obesity through behavioral and lifestyle strategies alone. “Catastrophic” was his word for the ten year investment in the Look AHEAD study with this goal. He was expressing dismay that so much investment went into a trial that yielded a null result. Of metabolic surgery he said, “This is certainly good for some people, but not for one billion people living with obesity.” By contrast, he pointed to emerging obesity medicines as having promise to provide scale for reducing the harm of obesity.

But, of course, many things will have to change before that promise becomes reality.

All Hands on Deck

If we learn anything from the magnitude of demand for advanced obesity medicines, it should be that we are at the beginning of some big changes in obesity care. Obesity medicine physician Beverly Tchang participated in planning this meeting and told us:

“Obesity is not a primary care disease, and it’s not a specialist disease. It’s an all-hands-on-deck disease.”

Broad themes of education, engagement, and empowerment emerged from the meeting. Cardiologists want more education about obesity because this is a disease they have never treated before. We all need to develop multidisciplinary teams to provide that treatment. This means engaging advanced practice providers (APPs), pharmacists, and community leaders. And finally, advocacy for the change will be critical. Cost control, coverage, and food industry reform will be essential, but how can change makers best push these forward?

Big Changes Have Started

It may be challenging, but the beginnings of big changes are already underway. Obesity care has long existed in a small bubble where it reached little more than a few privileged and wealthy people in specialty clinics.

But obesity is the most prevalent chronic disease of our age. We have tools that many more healthcare providers can use to manage it. Obesity care is coming out of its bubble. It’s about time.

For further insight on obesity care at scale, click here and here.

Reflection in a Soap Bubble, photograph by Mila Zinkova, licensed under CC BY-SA 4.0

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May 23, 2024