Joining the dots for the management of clinically severe obesity

Perceptions about the cause, prevention and management of obesity need to change

At its annual meeting in June 2013, the American Medical Association (AMA) adopted a policy that recognised obesity as “a disease requiring a range of medical interventions to advance … prevention and management”.1 On the first anniversary of this decision, with the firm support of relevant colleges and associations, the AMA went further by adopting a policy that supported patient access to the full spectrum of evidence-based obesity interventions, including behavioural, pharmaceutical, psychosocial, nutritional, pharmacological and surgical options.2 The next steps in delivering better integrated care in the United States will not be easy, as they will not only require a transformational change to health services, but also that community perceptions of obesity be confronted. These steps will need to recognise and manage clinically severe obesity (ie, significant health impairment, including comorbid conditions and functional status directly related to excess weight, regardless of whether body mass index [BMI] exceeds 35 kg/m2) as a chronic disease.3 We have already seen that incremental changes in health care service delivery, chronic disease models of care, and the widespread use of effective interventions have delivered markedly improved outcomes for people with type 2 diabetes in many countries.4 This experience provides a template for delivering better health outcomes for those with clinically severe obesity.