Bridging the gap: From obesity research to effective clinical practice

Recent advances in obesity research have considerably deepened our understanding of the condition’s underlying causes and the optimal strategies for its management. Despite these advances, a significant disparity exists in the application of this knowledge within clinical settings. This challenge has been meticulously outlined in the American Heart Association’s (AHA) scientific statement, “Implementation of Obesity Science Into Clinical Practice,” published in the Association’s leading journal, Circulation.

The statement asserts that obesity remains a critical public health issue, both in the United States and globally, affecting nearly all populations and imposing severe strains on healthcare systems. Obesity is a significant risk factor for heart disease, thus hindering progress in reducing heart disease rates. “Obesity is undeniably a critical public health concern in the U.S. and around the world, affecting nearly all populations and straining our health care systems. As a major risk factor for heart disease, obesity has significantly hindered progress in reducing heart disease rates. Despite advancements in understanding the complexities of obesity and newer treatment options, major gaps remain between obesity research and real-world implementation in clinical practice,” explains Deepika Laddu, Ph.D., FAHA, chair of the statement writing committee and senior research scientist at Arbor Research Collaborative for Health in Ann Arbor, Michigan.

The evidence strongly favours intensive lifestyle therapy, which is markedly more effective for weight loss than brief advice from healthcare professionals. However, the more common approach involves offering general educational information rather than directing patients toward specific classes, programmes, or tangible resources that facilitate lifestyle changes. One study highlighted that only 16% of healthcare professionals were knowledgeable about evidence-based lifestyle treatments for obesity, including diet and nutrition, physical activity, and intensive behavioural therapy referral. The barriers to effective weight management are further exacerbated by socioeconomic, racial, and ethnic disparities, with people of diverse backgrounds and those covered by Medicare or Medicaid less likely to be referred to or have weight management programs covered by their insurance.

Globally, the prevalence of obesity has been on the rise for around 30 years. Current estimates from the U.S. Centers for Disease Control and Prevention indicate that more than 40% of U.S. adults aged 20 and older are living with obesity. Research has elucidated the multifactorial causes of obesity, which include sociological and physiological determinants. Treatments have evolved to include more effective strategies for lifestyle modifications, medication therapy, and bariatric (weight-loss) surgery. Despite these advancements, each treatment approach faces its own set of challenges.

“Significant strides have been made in advancing the science to help us understand obesity, yet there remains a considerable gap between what we know and what happens in the doctor’s office,” Laddu observes. She emphasises the need for healthcare professionals and systems to better incorporate cutting-edge knowledge about obesity into practical applications so that more individuals can access appropriate support and treatment. This might include adopting new technologies and telemedicine, making referrals to community-based weight management programmes, providing social support, and enhancing the reach and access to treatments.

The statement discusses the FDA-approved Glucagon-like peptide-1 (GLP-1) agonists, such as high-dose semaglutide and tirzepatide, which are associated with an average weight loss of more than 10% at six months in clinical studies. Despite a large portion of the adult U.S. population meeting the BMI criteria for obesity and being eligible for these medications, a relatively small percentage currently use them. The historical lack of insurance coverage and high costs were significant barriers until recent policy changes by the Centers for Medicare and Medicaid Services allowed for the coverage of anti-obesity medications like semaglutide.

Weight loss surgery, or bariatric surgery, has seen improvements in safety, expertise, and understanding of its health benefits. A comprehensive review of studies on weight loss surgeries indicated that patients undergoing these procedures experienced lower risks of cardiovascular disease and reductions in other obesity-associated conditions such as Type 2 diabetes and high blood pressure. However, ensuring that the populations most in need have access to bariatric surgery remains a challenge due to cost, resource availability, and social support factors.

The statement further elaborates on the need for a comprehensive approach to obesity care, highlighting strategies to improve integration of obesity science into clinical practice and to develop solutions that manage obesity at the community level. The importance of education for healthcare professionals on the complex origins and clinical consequences of obesity is discussed, alongside the necessity for health policy changes to make obesity treatment more affordable, particularly for high-risk patients.

Specific approaches are highlighted in the statement to help bridge the gap between the science about obesity and clinical care, such as:

• To reach and successfully impact populations in need, healthcare professionals may consider how social determinants of health, including insurance type, household income, race and ethnicity, environment, health literacy, access to health-promoting resources, and social supports all influence the likelihood of successful patient treatment.
  
• Education for healthcare professionals explaining the complex origins and clinical consequences of obesity is discussed. Such training should emphasise information about diagnosis, prevention, and treatment of obesity. Despite the high prevalence of obesity around the world, there is a lack of education programmes centred on obesity for medical professionals.
  
• Further evaluation of health policy changes that healthcare systems and insurance plans can implement and scale in order to make obesity treatment affordable for patients, especially those at high risk for adverse outcomes such as cardiovascular disease.
  
• A framework for delivering obesity care into clinical practice settings is reviewed, as well as efforts by some professional societies for developing interventions that make obesity treatment more accessible.

“The statement emphasises the importance of a comprehensive approach across different levels of health care delivery and public policy, along with the adoption of feasible, evidence-based strategies in clinical settings,” said Laddu. “It also underscores the need for future research and policy changes to improve current patient care models and ensure equitable access to obesity-related care for people in underrepresented groups.”

The scientific statement also provides possible solutions for how to help people in their day-to-day lives, including interventions with digital technology and access through telemedicine. However, more research is needed in obesity science and treatment. Limited understanding of the cost-effectiveness of obesity prevention and the long-term health outcomes for established therapies has hindered the implementation of obesity science into clinical settings. Cross-collaborative obesity science research between stakeholders and health economists may serve as the bridge to developing and scaling cost-effective prevention programmes.

Further research into Food Is Medicine approaches in health care, such as medically tailored meals and produce prescriptions, to prevent and treat cardiovascular disease and other diet-related diseases are also being explored in several settings including the Association’s Health Care by FoodTM initiative.

This scientific statement was prepared by a dedicated volunteer group on behalf of various AHA councils, highlighting the critical need for increased awareness and informed healthcare decisions regarding obesity. While it outlines current knowledge and research needs, it refrains from making specific treatment recommendations, which are covered in the AHA’s official guidelines. This comprehensive approach underscores the necessity of closing the gap between advanced obesity research and its practical application in healthcare.