Closing Obesity Care Gaps: Understanding Trends and Treatments

December 27, 2022 - Current trends in obesity in the United States have concerned many healthcare professionals and public health officials. As the rates of obesity in the US continue to rise, many healthcare organizations are analyzing trends to determine the underlying causes, prevention strategies, and safe and effective treatments. The efforts are working to close the ever-present obesity care gaps, which impact nearly half of all adults in the United States.

Researchers in StatPearls note, “Obesity is an alarmingly increasing global public health issue. Several countries worldwide have witnessed a double or triple escalation in the prevalence of obesity in the last three decades, probably due to urbanization, sedentary lifestyle, and increased consumption of high-calorie processed food.”

According to the State of Obesity 2022 report by Trust for America’s Health (TFAH), between 2017 and 2022, the national adult obesity rate was 41.9%, meaning that nearly half of all adults in the United States were obese. These percentages mark a significant rise from the obesity rates between 1999 and 2000, which were 37% lower. While not as high as adult obesity rates, childhood obesity rates between 2017 and 2022 were still statistically significant, with 19.7% of children in the US being obese.

The report by TFAH determined that, as of 2022, 19 states have adult obesity rates equal to or greater than 35%, adding two states to the 17 from 2022 and 2021. This evidence and the current trends indicate existing issues that were further exacerbated by the COVID-19 pandemic.

While varying in magnitude, the rising rates have appeared across all age, sex, racial, and geographical groups, indicating that this is a widespread public health issue not contained to a particular patient population.

Understanding obesity trends, underlying factors, treatments, and prevention strategies is of significant importance for all stakeholders in the healthcare industry, as obesity is linked to an increased risk of many health conditions — including but not limited to diabetes, high blood pressure, depression, and stroke — in adults and children and roughly $170 billion in healthcare spending annually.

Impacts of Obesity

The public health impacts of obesity are seemingly never-ending, as this condition’s effects bleed into other aspects of life, including life expectancy, quality of life, disease prevalence, employment, and spending.

Data collected from the Framingham Heart study suggests that obesity in adulthood — at around 40 years old — is associated with a 6–7 year decline in life expectancy. This trend in life expectancy among obese populations is magnified in patients whose condition started in childhood and those with unhealthy lifestyle habits such as smoking or excessive alcohol consumption.

Beyond life expectancy, obesity can be associated with a worsened quality of life. It may limit physical function, impact energy levels, and increase the risk of other chronic conditions that reduce the quality of life. These chronic conditions may include type 2 diabetes, heart disease, stroke, cancer, asthma, and other respiratory illnesses. Often, patients who are obese forgo regular checkups due to fear of judgment, resulting in the unmanaged progression of these associated illnesses.

Additionally, obesity can be associated with significant healthcare spending, accounting for over 20% of all healthcare spending in the US. Many patients who are obese spend 30–40% more on healthcare due to an increased likelihood of comorbid conditions.

The impacts of obesity are expansive and pervasive, varying significantly for each patient depending on their medical history, risk factors, community, and access to care. With this in mind, addressing the obesity crisis in the US and minimizing its impacts on all populations must be a complex, multifaceted, and multidisciplinary effort, requiring contributions from legislative officials, healthcare professionals, patients, and the general public.

Proposed Solutions

Different resources, healthcare organizations, and stakeholders have proposed various solutions for addressing the obesity epidemic in the US, but the approach cannot be one-size-fits-all because the condition is not one-size-fits-all. With that in mind, the TFAH proposed multiple recommendations accompanied by detailed steps for addressing the obesity epidemic in the US. The five goals included efforts to advance health equity through federal resources, decrease food insecurity while providing access to high-quality, nutritious foods, address marketing and pricing issues that contribute to health disparities, increase access to physical activity, and work with healthcare industry members to address disparities in clinical and community settings.

Federal Resources

Under its proposition for advancing health equity through federal resources, the TFAH recommends multiple steps, including but not limited to the following:

• allocating more funding for the CDC’s obesity prevention programs
• expanding the social determinants of health (SDOH) program at the CDC — allowing for increased collaboration
• economic policy changes to combat poverty and its associated impact on obesity

Expanding federal resources can provide additional tools for developing healthy nutrition and exercise habits, accessing nutrient-dense foods, acquiring preventative care, assessing individual risk, and incorporating interventions.

Food Insecurity and Physical Activity

To decrease food insecurity and widen access to nutritious foods, the TFAH suggested making healthy school meals a permanent staple, developing rigorous nutrition standards for school meals, and widening access to government nutrition assistance programs.

Advancing nutrition standards in school can effectively reach children and adolescents most of the time. However, taking it one step further by widening access to government nutrition assistance programs can help consistently address concerns for a larger population of people.

Alongside nutrition, widening access to physical activity can take on many forms, including federal funding for physical education programs, regularly updated physical activity guidelines, and developing more community spaces for physical activity with the help of local government.

Physical activity has been proven to minimize obesity risk and improve cognition, heart function, muscle strength, and more. The current digital, work-from-home era has significantly reduced physical activity in the US, which may be contributing to the current obesity trends.

Closing Healthcare Gaps

Closing healthcare industry gaps is arguably one of the most important goals for addressing the opioid epidemic. This goal is broad because existing gaps vary from stigma to access and coverage.

The first of many steps to closing healthcare gaps is expanding coverage to include many populations and types of care. Obesity care begins far before a diagnosis and lasts well beyond reaching the desired goal. Comprehensive obesity care should include preventative education and counseling, regular checkups, patient monitoring when necessary, obesity medications when indicated, and so much more. For patients to seek comprehensive care, insurance must cover these services, and providers must make an effort to provide them.

Apart from access to these services, effective and equitable discussions around obesity cannot neglect information on weight-based stigma and discrimination. Weight-based stigma and discrimination can be expansive, including bullying, employment inequity, and lower-quality healthcare.

According to TFAH, “One reason behind weight-based discrimination is the unproven — but widespread — belief that people with obesity simply lack the self-discipline to eat less and exercise more. Science, however, is increasingly demonstrating that obesity is a chronic disease and its causes are complex and include societal, biological, genetic, and environmental factors, most of which are not under an individual’s control.”

With coverage varying drastically and other factors contributing to lower-quality care, TFAH recommends expanding health insurance coverage, including obesity-related preventive healthcare services in insurance coverage, and addressing SDOH concerning obesity.

Policy Changes

Additionally, policy changes to discourage the excessive consumption of foods that correlate with obesity can be very effective. In its report, the TFAH notes that the WHO recommends that beverages high in sugar be taxed as overconsumption is associated with high rates of obesity and other concurrent diseases.

According to TFAH, “In the United States, sugary beverages are among the leading sources of added sugar in American diets, and researchers have found taxing sugary beverages to be one of the most cost-effective obesity-reduction interventions, estimating a national tax could prevent half a million cases of childhood obesity over a decade.”

While the US has yet to adopt universal sugary beverage taxes, eight US cities have taken it upon themselves to do so, yielding positive short-term results. TFAH highlights the results of a 2021 study on Seattle’s beverage tax which has deterred the purchase and consumption of these products. Implementing these policy changes and addressing other concerns, such as marketing and pricing, can put the healthcare industry one step closer to minimizing and preventing obesity altogether.