1. Obesity treatment algorithm

In recent years, obesity has grown into a crucial public health concern in the United States and the rest of the world. Although it is a well-known issue, obesity rates have increased steadily within the past decade. Presently, over 12% of the global adult population is overweight and obese (WHO, 2020). According to Mitchell et al. (2011), obesity is an intricate illness characterized and associated with excessive accumulation of body fat and weight gain, which is detrimental to health.

Like any other disease, obesity impairs body functions like physical movement and reduces life quality. More importantly, obesity links to other chronic conditions, including cardiovascular diseases, cancers, hypertension, diabetes, pulmonary abnormalities, stroke, and respiratory complications. As noted by Wharton et al. (2020), 42.4% of the United States population was overweight and obese in 2018. Besides such an increase, recent studies indicate that incidences of critical obesity increased from 4.7% to 9.2% within the past decade (WHO, 2020). Moreover, the medical costs incurred by obese patients increased in tandem with the increase in government resources allocated to intervention. Despite its ravaging impacts on health, obesity is preventable and treatable. In this sense, individual researchers and health organizations have developed efficient algorithms to treat and manage obesity. Such algorithms involve assessment and management processes.

• Assessment
• Step 1: Interaction

Typically, any therapy involves assessment to establish whether the patient is affected by the condition in question. Similarly, the first step involves interaction between the patient and the health provider. According to Shin (2014), such interaction avails an opportunity for both parties to exchange information useful in counseling and treatment processes.

• Step 2: Health history assessment

Determining the origins of an illness is a crucial part of the assessment. In this case, health providers examine a patient’s health records and probe their medical history to establish whether they had previously been overweight or have a familial history associated with obesity. They also examine physical activity, medications, and dietary patterns, which are useful in establishing the cause of the condition (NHLB, 1998).

• Step 3: examining previous BMI scores

It is important to assess whether patients had undergone obesity examinations previously. In this way, there is less need to repeat the BMI tests if the patient is overweight, and if not, it provides a suitable opportunity to establish if the patient is gaining weight (NHLB, 1998).

• Step 4: Measuring BMI

According to the WHO, the BMI scale is among the standard measures used in computing adult obesity. The BMI scale determines whether a person is affected by obesity by dividing their body weight in kilograms by their height in meters. As per the measure, people with a BMI below 18 are underweight.  Although underweight people do not experience the problems associated with excess weight and obesity, they are highly at risk of developing nutrition-related disorders, immune system failure, cancer, respiratory complications, and osteoporosis (Shin, 2014). On the other hand, A BMI score ranging between 18-25kgM^2 signifies ideal/normal body weight. When the patient’s BMI score reads between 25-30kgM^2, they are considered overweight. Lastly, a BMI score equal to or greater than 30 signifies obesity. Although overweight may not be equal to obesity in clinical terms, it similarly signifies that a patient bears excess body fat and is at risk of developing cardiovascular diseases, type 2 diabetes,  various types of cancers, hypertension, osteoarthritis, and even psychological disorders (NHLB, 1998).

Even though the BMI scale is one of the fundamental measures used in examining obesity, it may not be suitable or efficient in specific contexts. For instance, specific people such as bodybuilders may have a high BMI score but are not overweight or obese. Again, since the BMI scale depends on the height, it does not accurately measure obesity in extremely short or tall people. More importantly, the BMI scale used to measure adult obesity is not applicable for children or adolescents since it does not consider vital factors like age and sex (Silveira et al., 2020).

• Step 5: Measuring waist circumference

In light of the shortcomings of the BMI scale, waist circumference provides a better way of measuring obesity and various health risks associated with bearing excess weight. During a waist circumference examination, the health practitioner measures the circumference of the abdominal area to determine whether a patient is overweight or obese. According to the American Heart Association, women with a waist size above 35 inches and men above 40 have abdominal obesity and risk developing cardiovascular diseases and T2D (Silveira et al., 2020). The waist circumference analysis is often conducted in addition to the BMI scale because both measurements efficiently measure and predict possible illnesses associated with obesity.

• Step 6: Health risk assessment

The health risk assessment is carried out in addition to the above tests to determine the factors that increase the risk of developing other conditions that usually present with overweight and obesity.  According to NHLB (1998), such factors include cigarette smoking, hypertension, a family history of cardiovascular diseases, high or low LDL (cholesterol) levels, physical inactivity, high blood sugar, and physical inactivity. In this case, high BMI scores mean that the patient has to lose weight to reduce the risk of developing obesity-related illnesses. In addition to the health risk assessment, health providers should probe patients on their lifestyle, diet, and behavior to identify the prominent causes of their situation

•   Step 7:  Making a decision based on steps 4, 5, and 6

Like any other therapy treating obesity is a process that demands total cooperation between the patient and the health provider. In this situation, the health provider gives recommendations according to the outcomes obtained from the BMI scale, the waist circumference, and health risk assessment (Shin, 2014). For instance, if a patient’s BMI is above 30, their waist is 45; the health provider could recommend weight loss as one of the treatment strategies. Nevertheless, implementing such a decision depends on the patient’s agreement, and the health risks involved.

• Management

Like evaluation, managing obesity is a complex process consisting of numerous internal procedures such as the following.

• Step 8:  Arriving at a joint decision

Since treating obesity involves the patient and the health provider, both parties must set clear goals and agree on the specific ways to attain such objectives. In this step, the patient and the health provider decide on the most practical ways to lose or maintain body weight. Such ways include making necessary dietary lifestyle and behavioral changes (NHLB, 1998). For instance, if the patient is overweight, they should lose at least half a pound each week. Although other interventions such as pharmacotherapy are applicable, they may only be suitable if dietary changes, physical activity, and lifestyle changes bear no results.

• Step 9: Assessing progress

After embarking on the six-month or 1-year weight loss program, it is crucial to assess the patient’s progress by retaking the BMI and waist circumference tests. If pharmacotherapy was applied in the weight loss and maintenance program, it is also important to assess possible side effects on the patient. In this step, if the patient manages to reduce their weight by 10% percent or more within six months or a year, it signifies that they are responding well to treatment. In this situation, the health provider should motivate the patient to maintain the new body weight.

• Step 10: Identifying the reasons for lack of change

            When no positive change is realized within the specified period, the health provider should investigate possible reasons why the patient could not lose weight. In so doing, they should keenly examine the patient’s mental health state, recent life events, energy intake, and energy expenditure. In another light, the health practitioner should check on the patient’s motivation to continue with the weight loss program. If there is motivation, both parties should re-assess the objectives and approaches. If the patient lacks motivation, the clinical therapy should cease, and the patient should be advised to avoid gaining more weight (NHLB, 1998). More importantly, if the current strategies have not attained any reasonable weight loss and the patient’s BMI exceeds 40, the health provider should consider surgical therapy.

• Step 11: Offering Maintenance counseling

According to Shin (2014), a higher percentage of obese patients regain weight shortly after losing it. In these circumstances, patients should be advised to carry on with their weight management programs to maintain their current health status and reduce the chances of regaining weight. In this step, health providers should maintain close and consistent contact with patients and educate, support, and monitor their progress.

• Step 12: Is the patient interested in losing weight?

Although most overweight people are not at risk of developing heart diseases and are reluctant to lose weight, they should maintain or reduce their weight. In this step, patients interested in losing weight should refer to steps 8 and 9 (NHLB, 1998).

• Step 13: Maintaining weight and addressing other health risk factors

If the patient is satisfied with the current weight’s appropriateness and does not wish to shed more, the health provider should advise and guide them accordingly to ensure that they maintain the present status.  The provider should ensure that the patient adheres to the specified dietary regimen, behavioral therapy, and physical activities. Additionally, both parties should embark on addressing the risk factors identified in step 6.

• Step 14: Differentiating patients with a history of overweight

In managing obesity, the health practitioner needs to investigate whether patients have a history of being overweight or a BMI≥25. In this phase, the health provider separates between patients with or without a history of being overweight to decide on whether they should reduce or maintain their weight

• Step 15: Reinforcement

Once the health provider identifies and separates the groups stated above, the health provider should advise and educate the patients who have never been previously overweight to maintain a BMI of ≥25 (NHLB, 1998).

• Step 16: Periodic BMI, Weight, and waist circumference assessment

Since creating and managing obesity is a continuous process, health providers should monitor the patient’s status at regular intervals to ensure the consistency and efficacy of the therapy (NHLB, 1998). Patients without a prior history of obesity should be assessed annually to identify early signs of weight gain and reduce the time and costs incurred in repeating examinations.

In addition to the steps discussed above, health providers should consider specific circumstances that may not be clinically appropriate for patients to lose weight. Such instances include pregnancy or evidence of health risks stemming from dietary changes, physical activity, or any other therapy. Generally, health practitioners should create a suitable environment by using patient-focused language, approaches, and motivation at all times.

•  Obesity risk factors

Observably, obesity has emerged as one of the most persistent public health concerns due to its interconnectedness with various risk factors. Such aspects include genetics, lifestyle choices, socioeconomic status, specific diseases, and age.

• Genetics and family history

Based on extensive studies, people with a family history of overweight and obesity are more likely to develop the condition due to genetics. In such situations, it may be challenging for patients to attain considerable weight loss even when they engage in physical activities or adopt dietary changes. Primarily, dietary patterns during pregnancy shape how the child’s body stores and utilizes excess fat. For instance, according to (Corica et al., 2018) overweight fathers undergo DNA changes that pass onto their children through sperms. In this way, their children develop obesity later in their life. In another light, studies have established that specific races like Asians and African Americans are more predisposed to obesity than Whites.

• Behavioral and lifestyle choices

Typically, staying healthy relies on consuming a healthy diet and engaging in physical activities to burn excess calories. From this perspective, numerous studies associate overweight and obesity with unhealthy dietary patterns and lack of physical activity. For instance, due to technology, most people in contemporary society have adopted a sedentary lifestyle. According to Kim et al., (2019), such lifestyle is characterized by passive activities like watching television, playing video games, or drinking alcohol. Due to this situation, most people with such behavior are at risk of developing obesity and other nutrition-related illnesses such as type 2 diabetes.

• Age

As stated, childhood and adolescent obesity is a critical problem in the United States and the rest of the world. Nevertheless, research shows that the incidence and prevalence of obesity worldwide increases with age because other risk factors like lack of physical activity, drug and substance use, and unhealthy food consumption present with age (Villareal et al., 2005). More importantly, addressing adult obesity is challenging because young adults gain more weight and exhibit more health risks as they grow.

• Unhealthy environments and socioeconomic issues

The rapidly increasing obesity rates reflect on how unhealthy most environments are. For instance, there are more cases of adult obesity in urban areas due to a sedentary lifestyle and increased intake of high-calorie foods and sugary drinks that are readily available in most convenience stores. On the other hand, rural areas also have high obesity rates due to a lack of knowledge on illness, poverty, unhealthy behaviors such as smoking, and increased physical inactivity. According to Brennan et al. (2009), most children in rural areas in the United States develop obesity because they consume whole grain meals, rarely eat fruits, and are physically inactive due to lack of facilities such as sidewalks, parks, and fitness training centers. Again studies on the effect of socioeconomic status on the prevalence of obesity show that people with higher social status are less likely to gain weight since they can afford to exercise and consume a healthy diet (Brennan et al., 2009).

• Diseases

Although obesity is an illness in itself, it can stem from other conditions in some cases. For example, if a person has arthritis, their physical movement is impaired, and thus they are more likely to become overweight, obese, and diabetic (Villareal et al., 2009). Similarly, other diseases like Cushing syndrome and Prader Willi syndrome increase the risk of developing obesity. On the other hand, specific medications such as antidepressants, diabetes medications, psychotropics, and anti-seizure medicines also contribute to excessive weight gain and obesity.

• Other factors

In addition to the aspects discussed above, several other risk factors increase the likelihood of developing obesity. Firstly, Lovejoy & Salsbury (2009) pointed out that sex as a crucial predictor of incidence and prevalence of obesity. In this sense, extensive studies show that women have a higher risk of developing abdominal obesity compared to men. Besides, specific conditions like pregnancy are associated with weight gain and obesity even after childbirth. Moreover, therapeutic processes such as quitting smoking are associated with increased food intake and obesity.

Complications

While treating and managing obesity is critical, health providers should recognize the risks and complications linked to the treatment algorithms. For instance, when addressing obesity in older adults, health providers should caution patients on weight loss programs because older people have higher bone and muscle wasting rates, which might endanger their health (Villareal et al., 2009). More importantly, there is scanty research on the most suitable approaches useful in addressing adult obesity.

Reference

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Corica, D., Aversa, T., Valenzise, M., Messina, M. F., Alibrandi, A., De Luca, F., & Wasniewska, M. (2018). Does family history of obesity, cardiovascular, and metabolic diseases influence onset and severity of childhood obesity?. Frontiers in endocrinology, 9, 187.

Kim, D., Hou, W., Wang, F., & Arcan, C. (2019). Peer Reviewed: Factors Affecting Obesity and Waist Circumference Among US Adults. Preventing chronic disease, 16.

Lovejoy, J. C., Sainsbury, A., & Stock Conference 2008 Working Group. (2009). Sex differences in obesity and the regulation of energy homeostasis. Obesity Reviews, 10(2), 154-167.

Mitchell, N. S., Catenacci, V. A., Wyatt, H. R., & Hill, J. O. (2011). Obesity: overview of an epidemic. The Psychiatric clinics of North America, 34(4), 717–732. https://doi.org/10.1016/j.psc.2011.08.005

National Heart, Lung, Blood Institute, National Institute of Diabetes, Digestive, & Kidney Diseases (US). (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report (No. 98). National Heart, Lung, and Blood Institute.

Shin, M. S. (2014). Management of Overweight and Obesity: Review of the. Korean Journal of Medicine, 87(2), 136-141.

Silveira, E. A., Pagotto, V., Barbosa, L. S., Oliveira, C. D., Pena, G. D. G., & Velasquez-Melendez, G. (2020). Accuracy of BMI and waist circumference cut-off points to predict obesity in older adults. Ciencia & saude coletiva, 25, 1073-1082.

Villareal, D. T., Apovian, C. M., Kushner, R. F., & Klein, S. (2005). Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. The American journal of clinical nutrition, 82(5), 923-934.

Wharton, S., Lau, D. C., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., … & Wicklum, S. (2020). Obesity in adults: a clinical practice guideline. Cmaj, 192(31), E875-E891.

World Health Organization. (2020). Overweight and obesity.