The American Heart Association (AHA) advises that clinicians follow a “5A model” when implementing obesity science into clinical practice, according to a scientific statement published in Circulation.
More than 40% of adults in the United States (US) are living with obesity. Despite this high prevalence, major gaps between the science of obesity and its clinical implementation exist. Bridging the gaps between science and clinical practice requires a multitargeted approach involving clinicians, the community, and the health care system.
Advancing knowledge about treatments for obesity begins in the laboratory with the ultimate goal of improving health outcomes for patients. Obesity research starts with preclinical and genetic studies and progresses to human-based trials. The AHA opines that the results of these studies must be implemented into policy and practice through guideline recommendations and delivery of care, which will ultimately influence public health.
However, the implementation of obesity science can be affected and hindered by multiple confounding factors, including population heterogeneity, unproven effectiveness of weight loss interventions, a disconnect between science and economics, a lack of public support, limited resources, and the lack of an integrated health system in the US.
Building obesity care around these principles requires substantial financial input and engagement from multiple stakeholders. Still, the rewards of lower mortality, long-term health care cost savings, and improved quality of life warrant the investment.
For example, recent study findings showed that a minority of health care practitioners (16%) could identify which lifestyle treatments for obesity were evidence-based, few patients (23%) discuss their weight or lifestyle changes with their clinicians, and anti-obesity medications remain under-prescribed.
The AHA recommends implementing the 5A model (assess, advise, agree, assist, and arrange) to apply obesity science in primary care:
- Assess: Identify the patient’s knowledge about treatments and motivations for receiving obesity treatment by asking open-ended questions. Identify the patient’s lifestyle and clinical risk factors for obesity and their barriers to treatment success.
- Advise: Provide patient-centered guidance about treatment options by presenting risks and benefits of each option while considering the patient’s intentions.
- Agree: Support the patient’s decision-making process and come to an agreement on specific treatment goals and strategies.
- Assist: Develop a plan of action to achieve and maintain treatment goals by anticipating treatment barriers and engaging in problem-solving discussions.
- Arrange: Schedule follow-ups to support the patient and check in on their progress. Refer the patient to a specialist or to community resources when appropriate.
For clinicians who lack knowledge about evidence-based nutrition, physical activity, pharmacotherapy, and surgical information about obesity, the AHA recommends undergoing additional training and referring patients to an obesity medicine specialist. Similarly, clinicians who are not comfortable discussing weight management with their patients should seek additional training and engage with community health workers.
The AHA concluded, “Despite decades of advancement in our scientific understanding of the pathophysiology underlying obesity and its potential treatment, a substantial gap between that knowledge and the successful implementation of obesity science to treat obesity within clinical practice remains. […] Building obesity care around these principles requires substantial financial input and engagement from multiple stakeholders. Still, the rewards of lower mortality, long-term health care cost savings, and improved quality of life warrant the investment.”
References:
Laddu D, Neeland IJ, Carnethon M, et al. Implementation of obesity science into clinical practice: a scientific statement from the American Heart Association. Circulation. Published online May 20, 2024. doi:10.1161/CIR.0000000000001221
