Evolving Obesity Care: How Do We Get There from Here?

Highway and BywaysIt is unmistakable, Lee Kaplan tells us. Obesity care is evolving. But the change is painfully slow and inadequate – especially in comparison to the rapid advancement in tools for treating obesity. The slow progress is especially painful when you compare it to the progress made against HIV or COVID. In 1984, HIV was almost uniformly fatal. Today, it barely affects life expectancy.

Yes, obesity care is evolving, but the advancement of obesity science demands that we pick up the pace of change.

Kaplan delivered – as usual – perspective on the field with remarkable clarity when he opened the 2024 Boston Course in Obesity Medicine yesterday.

The Disease and the Culture

Making the changes that we must requires us to  fully understand why obesity is a disease and how this disease differs from the pervasive cultural desire for thinness. We can learn from other diseases that dealing effectively with a disease requires us to follow certain medical norms.

Understanding the barriers to effective obesity care and the diverse forces working against such care will be an essential part of the process.

But most of all, the needs and goals of the people living with obesity will have to guide every part of this process. This is not easy. Because many have been previously misled and scarred by the bias, stigma,
blame, and discrimination that surrounds them. Not to mention misinformation and quackery.

Rewards for Change

In Kaplan’s telling of this evolution, the rewards for success will be great.

We can expect to see an effect on obesity at a population level, starting with a reduction in the severity of the obesity people already experience. Later, we might see a reduction in the rate of obesity, as effective treatment gives rise to genuinely effective prevention strategies. The evidence is already accumulating that obesity care can bring improvement or reduction in the major complications of obesity. Gains against the toll of diabetes, heart disease, kidney disease, liver disease, and obesity-associated cancers are likely.

Other benefits are conceivable. With effective obesity treatment, people can enjoy advances in mental health and quality of life. Beneficial effects on social capital, life expectancy, economic productivity, and even health care costs are possibilities. We might even see food industry incentives moving from quantity to quality. In this way, the social environment could move that industry toward a more positive role in our food environment.

Meeting the Need

All of these changes could generate the greatest benefit in populations with the highest current rates of obesity. But only if we succeed in providing access to obesity care that is both sufficient and equitably distributed.

Ask yourself: can you contribute to making this vision a reality?

Click here for the slides from Kaplan’s presentation.

Highway and Byways, painting by Paul Klee / WikiArt

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June 14, 2024