As the field of obesity medicine matures, clinicians and patients are asking: “What is the treatment target?”
- achievement of a targeted percentage weight loss?
- improved body mass index (BMI) or waist circumference?
- better function and quality of life?
- remission of weight-related complications?
- ability to taper or discontinue medications for other chronic disease treatments?
- or – all of the above?
Though both hypertension and diabetes are chronic diseases requiring ongoing treatment, clinicians do have more targeted goals related to blood pressure and HbA1c, respectively.
One confusion with obesity treatment is that the headlines are all about a narrowly focused goal of weight loss.
But what about all the health gains that are so vital to a healthier and productive life?
As in all chronic disease treatment, clinicians need to have conversations upfront with patients about treatment goals and expectations.
This is an essential component of offering patient-centered care and will lessen the likelihood of patient disappointment or discontinuation of treatment.
As the obesity medicine field continues to evolve, here are some ‘treat to target’ principles to guide clinicians as well as the patients they treat:
1-Know the Advancing Medical Data on Obesity Treatment and Goals
Firstly, achieving any amount of weight loss is beneficial to health and should be celebrated.
However, not all weight-related complications respond to weight loss the same way.
For example, whereas 3% weight loss will likely improve mildly elevated blood pressure, blood sugar and triglycerides, 10% to 15% weight loss is needed to improve sleep apnea or risk of having a second heart attack or stroke.
Other studies have shown that improvement of mechanical complications of excess weight (like knee arthritis) is best predicted by reduction in BMI, whereas cardiometabolic complications (like diabetes, hypertension and heart disease) are most responsive to reductions in waist circumference.
These target thresholds should be considered before and during treatment with the goal of achieving improved health and control or remission of weight-related complications.
2-Use Patient-Centered Care to Apply Data to Each Patient
Knowing the data is important, but developing a personalized plan and targeted treatment goals that are realistic for each patient is key.
Your patient’s age, life situation and stressors, resources, health history and social determinants of health – all play a role in developing a targeted treatment plan.
3-Let Shared Decision Making Lead the Way
While it is the clinician’s responsibility to review medical weight loss outcome data, patients must express their own reasons for losing weight along with personal preferences regarding treatment approaches.
Optimal goal setting would integrate improvements in weight-related complications, physical function, and quality of life that is guided by ‘treat to target’ data.
Treatment of patients with the chronic disease of obesity is not a one and done endeavor.
Follow-up, accountability and referral to team members all play a role when responses to obesity treatments change or life gets in the way of one’s best intentions.
In summary, ‘treat to target’ is not a fixed number or just one thing, as it varies with each patient clinicians treat.
RK
Robert Kushner, MD
