Obesity Survey Uncovers Striking Clinician 'Knowledge Gap'
Written by Editor   
Sunday, May 08, 2016 12:00 AM

Two-thirds of US clinicians who replied to a survey about treating obesity reported that they prescribe weight-loss drugs for about one in four obese patients, and they refer 13% of individuals for bariatric surgery. However, in a somewhat-troubling response, they also said that half of the patients who took weight-loss drugs did not meet their "treatment goals."

The most striking observation from the survey is that it demonstrates a considerable knowledge gap in the indications, efficacy, and safety of currently FDA-approved drugs for obesity that affect prescribing these medications.  Nevertheless, “Believe it or not this is improvement and appears to indicate more healthcare providers are treating obesity,” the report notes.

The survey replies suggest that clinicians are trying to help their patients manage their weight, but they are frustrated because their patients are struggling with lifestyle change.  The surveyed practitioners reported that they typically treated about 80 obese patients and 110 overweight patients a month, and about 30% to 60% of these patients had type 2 diabetes, hypertension, or other obesity-related conditions.

Overall, 59% of the respondents (ranging from 40% of the ob/gyns to 65% of family-medicine physicians to 85% of the endocrinologists) prescribed weight-loss medications.

The fact that 85% of endocrinologists and 65% of primary-care providers are prescribing drugs for weight management "is a huge change" from what would have been seen 5 years ago.

Most practitioners used a diet-modification approach (85% of respondents) or exercise (80%) to treat their overweight or obese patients, but far fewer used behavior therapy (40%) or weight-loss medicines (about 20%).  About one in four respondents said they didn't want patients relying on drugs or they don't believe that the medications work.

The low use of behavioral-therapy strategies indicates that clinicians still need to improve their “coaching" skills, to help patients make changes in diet and physical-activity habits. “This all falls on a lack of education,” the report added.  Education about treating obesity needs to start in medical and nursing schools and eventually be part of lifelong continuing professional education, she stressed.

"If the respondents are saying patients are not meeting goals, this means they are not treating to the right goal," stressed Dr Ryan. Success should be defined as improvements in health targets, not a number on a scale, and patients can achieve this with a 5% to 15% weight loss, she observed.

The survey shows that "obesity needs to be considered a chronic disease." Although "remission" is often not possible with current treatment approaches, a moderate, 5% weight loss has considerable health benefits and should be considered a reasonable treatment goal for many patients, and many will be able to achieve this type of weight loss with lifestyle therapy with or without obesity medications.

Source: http://www.medscape.com/viewarticle/861084