The Obesity Medicine Association, the Academy of Nutrition and Dietetics, and Atlas Clarity recently partnered with key leaders to develop the new Nutrition and Obesity Management in the Context of Anti-Obesity Medications: A Blueprint for Action. This Blueprint for Action lays out actionable steps that can be taken by everyone who has a stake in creating comprehensive obesity care management for older Americans.
Why Comprehensive Obesity Care Management for Older Adults Is Crucial
Approximately 39% of Americans ages 60 and older are living with obesity, as are 46% of those ages 40–59. Obesity is a complex, chronic disease that can significantly impair healthy aging, increasing the risks of developing many other chronic conditions, including diabetes, heart disease, stroke, cancer, mental illness and pain. To help treat obesity and associated chronic conditions, 8% of older Americans have turned to anti-obesity medications (AOMs), such as glucagon-like peptide-1s (GLP-1s like Ozempic and Mounjaro) that are frequently in the news. These medications help many older adults lose weight, but, unfortunately, some of that weight loss can be due to the loss of muscle and bone mass.
Less than 9% of patients on anti-obesity medications visit a dietitian before starting them.
Losing muscle mass is a danger to healthy aging, as it can negatively impact strength and mobility, and increase the risk of falls and fractures. The best way to address such potential side effects posed by AOMs is through comprehensive obesity care management, which includes nutrition (see Figure below).
Figure: There are four key pillars of comprehensive obesity care management.
- Nutrition Therapy: Focusing on healthy eating patterns and dietary choices.
- Physical Activity: Emphasizing regular movement and exercise.
- Behavioral Modification: Addressing psychological factors and lifestyle changes.
- Medical Interventions: Utilizing medications such as AOMs when appropriate.
GLP-1s can affect diet. Nutrition therapy includes regular visits with a registered dietitian nutritionist (RDN), who focuses on an individual’s diet to help ensure people on AOMs maintain adequate protein intake and to help manage common side effects such as nausea and dehydration. Doing so can help mitigate muscle loss and maintain function.
The Need for the Blueprint for Action
Unfortunately, many older adults do not receive comprehensive obesity care. This is due to a variety of factors, including inadequate insurance coverage, particularly for those on Medicare, and a general lack of nutrition screening and referrals to RDNs. Less than 9% of patients on AOMs visit a dietitian before starting the medication, leading to high rates of medication discontinuation.
Specific actions, such as passing the federal Treat and Reduce Obesity Act (TROA) can be helpful in improving access to quality obesity care. However, for a systemic change that supports nutrition as part of comprehensive obesity care management, a more comprehensive policy approach is needed to leverage effective engagement and coordination across stakeholder groups. This Blueprint for Action helps address this gap by laying out what each stakeholder group can do in the short-, mid-, and long-term to advance comprehensive, patient-centered nutrition and obesity care management for all individuals living with obesity. Specific stakeholder groups addressed in the Blueprint for Action are:
- Patients: Patients are at the center of comprehensive obesity care management. As such, their role is largely to provide clinicians and researchers with the data needed to improve care. This includes participating in research, completing patient-reported outcome measures, and voicing treatment preferences. In addition, patients can serve as advocates and educators, using their lived experiences to improve public perception of the importance and value of comprehensive obesity care management.
- Clinicians: There is a wide array of clinicians who contribute to providing comprehensive nutrition and obesity care: primary care providers, including physicians and advanced practice providers such as nurse practitioners and physician associates, pharmacists, obesity medicine specialists, RDNs, exercise physiologists, mental health providers, and more. It is their responsibility to provide the foundation upon which comprehensive obesity care is built by defining the standard of care and creating comprehensive obesity care management guidelines. Clinicians must also be responsible for leading education and training initiatives for current and future practitioners, as well as the public.
- Advocates: Advocates play a pivotal role at the intersection of science and policy. The primary role of advocates is to ensure the uptake and adoption of care standards developed by clinicians.
- Researchers: Researchers provide the essential evidence base for effective obesity care. Their work should demonstrate intervention impacts, test innovative models, and generate findings that lead to the development and refinement of clinical care guidelines.
- Policymakers: Policymakers’ role is to ensure accountability across the healthcare system, including clinicians, hospital systems, and payers. To do so, policymakers must create mechanisms to support adopting comprehensive obesity care management best practices.
The Blueprint for Action provides additional detail on each of these recommendations, laying out the necessary, multi-stakeholder path forward. It discusses the need for standardized data, a coordinated research agenda, evidence-based guidelines, supportive policies, and widespread education. Implementing these recommendations demands urgent and collaborative action from all stakeholders. Ultimately, this integrated approach can help prevent fragmented care, effectively address the complexities of obesity care management, mitigate associated health risks, and identify opportunities for cost-effective strategies.
We urge all stakeholders to read the Blueprint for Action and take specific actions to advance quality nutrition and obesity care that can better support the millions of older individuals living with obesity who are using AOMs to age well.
Jeffrey Berko is a senior research manager for Atlas Clarity in San Francisco, Calif.Photo credit: Shutterstock/Sarawut Kh
