Gaps remain between what's known about obesity and how it's being treated

Obesity rates in the U.S. continue to rise, thwarting progress in reducing the rate of heart disease and stroke. But scientific advances in how to treat obesity often don't make it into clinical practice, according to a new report.

The scientific statement from the American Heart Association, published Monday in the journal Circulation, highlights gaps between the growing understanding of the causes and treatments for obesity and how it is being managed by health care professionals. It also outlines barriers to properly addressing weight loss, such as a lack of insurance and lack of knowledge about evidence-based lifestyle interventions.

"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," Dr. Deepika Laddu, chair of the statement writing committee, said in a news release. Laddu is a senior research scientist at Arbor Research Collaborative for Health in Ann Arbor, Michigan.

But, despite significant scientific strides in understanding obesity, "there remains a considerable gap between what we know and what happens in the doctor's office," she said.

Obesity rates have been increasing in the U.S. and worldwide for nearly 30 years. More than 40% of U.S. adults live with obesity, a major risk factor for heart disease and stroke, according to the Centers for Disease Control and Prevention.

Recent advances in research have led to a deeper understanding of the complex causes of obesity, including the role of sociological and physiological determinants of health. Treatment advances have also created more strategies for lifestyle modifications, medication therapy and weight loss surgery, but each option carries challenges.

For example, newly approved medications, such as glucagon-like peptide-1 agonists that include high-dose semaglutide and tirzepatide, have been linked to weight loss. But while half of U.S. adults meet the criteria for a prescription, they are not being widely prescribed.

Until recently, the primary barriers to increased use of these obesity medications included a lack of insurance coverage and high out-of-pocket costs. In March, Medicare and Medicaid were allowed to cover semaglutide after the Food and Drug Administration approved the medication to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. State Medicaid programs are required to cover nearly all FDA-approved obesity medications, but the plans may require step therapy with other treatments or medications.

Advances in weight loss surgery over the past several decades have made it a more viable option for some, with improvements to safety and studies showing evidence of numerous health benefits, such as lowering the risk for cardiovascular disease and other obesity-related conditions. However, challenges with cost, resources and social support mean not everyone who could benefit from this surgery can access it.

"Health care professionals and health care systems need to find better ways to put what we know about obesity into action so more people can get the right support and treatment," Laddu said. "Adopting new technologies and telemedicine, making referrals to community-based weight management programs to encourage behavioral change, providing social support and increasing reach and access to treatments are just some of the promising methods we could implement to unlock successful evidence-based obesity care."

The report highlights the need to consider how social determinants of health, such as insurance coverage, household income, race and ethnicity, health literacy and access to resources affect a person's likelihood of receiving proper treatment. It also calls for educating health care professionals about the complex origins and clinical consequences of obesity.

The new statement "emphasizes 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," Laddu said. "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."