A Proposed Standard of Care for Adult Obesity
Although several obesity treatment guidelines have been published for obesity specialists, many patients report that it is difficult to receive the care they need because the standards for obesity care are so disparate across health care settings.
During 2018, the STOP Obesity Alliance convened a series of roundtable meetings with relevant stakeholders to deliberate about who should provide obesity care, where obesity care should be delivered and what care should be provided by whom. It was our goal to develop a standard of care to enable the patient to move within the continuum of care, as well as to provide assurance that patients have access to appropriate levels of care, regardless of where they enter the healthcare system.
The product of our meetings was a practical, tangible, measurable and simple standard of care for the treatment of adult obesity, published in the July 2019 issue of Obesity. No comparable standard addresses the spectrum of care that persons with obesity need to address their disease.
The recommendations proposed are intended to provide health professionals, payers, community organizations, policymakers and those affected by obesity with guidance on foundational components of evidence-based obesity care. The recommendations are intended to reach across care settings and represent evidence-based practices that positively impact the health of people affected by obesity.
This new standard of care is based on eight core principles, including shared decision-making, when to use adjunctive therapies, and when to move patients to higher intensity treatments. Because effective and evidence-based obesity care occurs in a variety of settings, our recommendations are divided into two sections: 1) those that apply to all providers, including clinical, community and digitally based entities, and 2) those that apply specifically to clinicians, such as prescribers, for whom a more detailed knowledge of obesity pathophysiology is required. In addition, the standards include a proposed algorithm for how health plans could assess their success in obesity management (Figure 1).
Through research connected to this work, we have also found that insurance coverage for obesity care varies greatly across insurance plans. For our next steps, we have begun the process of drafting and seeking input from experts and stakeholders on what would constitute an ideal obesity care benefit based on our proposed standard of care. We recommend that payers cover and reimburse evidence-based programs and interventions from randomized trials that:
- produce a 5% or greater weight loss for a clinical intervention;
- produce a 3% weight loss for a community-based intervention;
- prevent the onset or reduce the severity of obesity-associated comorbidities; and/or
- support weight maintenance that is sustained over 6 months.
We would welcome your thoughts and feedback on the standards or on future work on this project.