GENERAL STRATEGIES FOR OVERWEIGHT AND OBESITY PREVENTION AND ADVOCACY

Every healthcare professional has the opportunity to guide their patients toward making healthy lifestyle choices. Healthcare providers can be role models and bring their knowledge and standing to advocate for healthy changes that connect with people well beyond the healthcare facility they are working in. Every healthcare professional must have the skills to counsel patients about obesity prevention.

Recommendations are provided below for healthcare professionals working with various patient populations in various specialties.

Primary Care Practices

The following recommendations have been made for adults in primary care:

Measure BMI in all adult patients.
Order appropriate follow-up laboratory tests for patients who are overweight and obese.
Prescribe a long-term treatment strategy that may include:
- Counseling, coaching, or behavioral interventions on diet and lifestyle change
- Weight-loss medication for appropriate patients who have been unable to lose weight using conventional therapy and who have no contraindications
- Bariatric surgery for those individuals with severe obesity unable to lose weight through conventional therapy and who have no contraindications
Design offices to avoid stigmatizing overweight or obese individuals, such as providing private weighing areas and using scales that can measure weights greater than 300 pounds.
(Harvard T.H. Chan, 2022d)

Pediatric Care Practices

The newest research in children indicates that healthcare interventions in a clinic or office setting in the absence of broader community strategies to prevent obesity may lead to behavior change but may not be adequate to result in sizable improvements in weight. It is therefore recommended that clinic efforts be combined with communitywide changes, such as the “Collaborate for Healthy Weight” initiative. For all children seen in pediatric offices, recommendations include:

Measure BMI-percentile-for-age at every well-child visit for children ages 2 years and older; measure weight-for-length percentile for children under 2 years.
Counsel all patients and families on healthy eating, physical activity, and healthy growth, regardless of current weight status.
Counsel all patients and families to limit television time to no more than two hours per day and to remove televisions from children’s bedrooms.
Counsel all patients and families to limit consumption of sugar-sweetened beverages.
Counsel all patients and families to help children achieve 60 minutes of moderate to vigorous physical activity per day.
Establish procedures for follow-up assessment (including laboratory tests), counseling, and treatment plans for children who are overweight or obese.
Establish policies to avoid weight bias in pediatric clinics, which may include requiring all employees to be trained on weight-bias prevention.
(Skelton, 2021; Harvard T.H. Chan, 2022d)

Obstetrical Care Practices

There are many factors before and during pregnancy that can affect a child’s obesity risk later in life. The following recommendations pertain to obstetrical care practices:

Counsel patients on the importance of having a healthy weight before pregnancy and gaining weight at a healthy rate during pregnancy (15–25 pounds for overweight women, 11–20 pounds for obese women).
Early ultrasound evaluation should be performed to establish gestational age and to determine whether there is a multifetal gestation.
Recommend that mothers breastfeed their babies and provide support and training for breastfeeding.
Counsel patients on the importance of discontinuing smoking during pregnancy.
Screen pregnant women for gestational diabetes.
Counsel patients on primary weight-management strategies during pregnancy, including dietary control, exercise, and behavior modification. Working with a nutritionist can help patients plan meals for optimum health gestational weight gain.
Almost all drugs prescribed for weight reduction have adverse fetal effects and should not be used during pregnancy.
If pregnancy occurs before the recommended timeframe for women who have had bariatric surgery, closer surveillance of maternal weight and nutritional status as well as serial monitoring of fetal growth will be beneficial.
(Palaszewski, 2021; Harvard T.H. Chan, 2022d)

Hospital and Clinic Efforts

The following are recommendations for helping in the prevention of obesity in hospital settings:

Encourage healthcare providers to model healthy eating.
Offer healthy foods and beverages to employees and patients.
Ban the sale and marketing of unhealthy foods and beverages on clinic and hospital premises.
Promote breastfeeding among new mothers who give birth in the hospital or clinic, as well as for hospital and clinic employees who are nursing.
(Harvard T.H. Chan, 2022d)

Health Insurance Providers

Recommendations put forth to insurance providers include advocating for the following:

Cover obesity-related services that include assessment, prevention, evaluation, treatment, and follow-up, and streamline reimbursement procedures.
Create and promote prevention programs that can be instituted plan wide.
Provide subscribers with incentives for maintaining healthy body weight or adopting healthy behaviors.
Measure and track progress in BMI screening through Healthcare Effectiveness Data and Information Set (HEDIS) data collection.
Fund obesity prevention efforts in the community and/or participate in community obesity prevention coalitions.
(Harvard T.H. Chan, 2022d)

Individual Healthcare Professionals

Each healthcare professional can serve as a leader and role model—both within one’s area of practice and in the community—to encourage healthy behaviors and to make changes in the built environment. Professionals can advocate at professional organizations, local, state, and federal levels for policy and built environment changes promoting healthy eating and physical activity in healthcare settings, childcare settings, schools, after-school programs, and communities. Healthcare professionals can encourage parents to advocate for changes in the environment that promote physical activity in their children’s schools and communities (Harvard T.H. Chan, 2022d).

Ending Weight Stigma in Healthcare

Substantial evidence demonstrates the widespread experiences and impact of weight stigma that is ultimately leading to inequitable healthcare for those living with obesity. The overwhelming evidence that such weight stigma in healthcare is detrimental must be addressed. Aligned with the WHO call for zero discrimination in healthcare, there is a need for:

Treating all patients, no matter their background or appearance, with respect and dignity
Ensuring that everyone has equal opportunity to access quality care in a timely fashion
Developing education resources about the complexity of obesity and the impact of weight stigma for both current and future healthcare professionals
Addressing the stigmatizing framing of obesity policies and campaigns to remove fear, frustration, pessimism, and blaming
(Flint, 2021)

Barriers to the Provision of Weight Management in Primary Care Clinics

The current outcomes of obesity treatment indicate a failure of both patients and physicians in initiating or maintaining interventions. Recent studies have been done to identify and understand the barriers to obesity management in clinical settings from the points of view of both patients and healthcare providers.

Healthcare provider factors:

Healthcare providers (HCPs) cite limited appointment time for patient visits as the principal reason for not discussing weight management with their patients.
Insufficient training and counseling skills for obesity make is difficult for HCPs to provide counseling for obesity. Obesity education for HCPs includes diverse fields such as diet, nutrition, exercise, behavior therapy, and medication. Medical schools are urged to adequately address obesity education in their curricula.
Despite its recognition as a chronic disease, obesity is underdiagnosed. HCPs must proactively screen for obesity and initiate discussions in obesity management. A survey indicates that 55% of patients with obesity received a formal diagnosis, 38% discussed a weight-loss plan with their provider, and 24% were scheduled for a follow-up appointment.
(Kim, 2020: Weller, 2021)

Patient factors:

Awareness. Obesity is not recognized as a chronic and relapsing disease.
Misbelief and misinformation. Rather than seeking advice from HCPs, individuals use alternative sources of information such as the internet, family and friends, television, and smartphone applications.
Environmental factors. Successful weight loss may depend on family functioning or finding a support system within and/or outside the family. Successful adherence to long-term lifestyle changes requires a strong support network.
Cost, particularly for patients with low socioeconomic status. Obstacles include the higher cost of healthy foods and financial inability to take part in weight-loss programs or to use an exercise facility. Unlike medical treatments for other chronic disease, obesity medications are generally not reimbursed by healthcare systems.
(Kim, 2020)