We Know More About Obesity Than Ever Before. So Why Do Our Numbers Keep Getting Worse?

By: Linda Anegawa, M.D., F.A.C.P.

It is extremely rewarding to see that obesity care has grown way beyond “eat less and exercise more.” Way beyond “willpower,” “just do it,” and endless cabbage soup as a promise to achieve the physique of your dreams. It’s not about appearance and unrealistic beauty standards.  It’s all about health: reducing the risk of disease and improving quality of life.   As an Obesity Medicine-Board Certified specialty physician – dedicating my entire professional life to this disease – I see all this as incredibly positive.

Still, as a nation, our numbers are getting worse, not better. The most recent data from the National Health and Nutrition Examination Survey reveal that the obesity prevalence has now grown to just over 36% in US adults and 17% in youth.

On October 31, 2016, the largest international conference dedicated entirely to the care and treatment of obesity, convened in New Orleans, Louisiana.  Obesity Week 2016 brought together renowned experts to advance research, treatment methods, and obesity prevention methodologies.

A joint effort of The Obesity Society (TOS) and the American Society for Bariatric and Metabolic Surgery (ASMBS), this meeting has clearly become the leading conference of its kind in the world.  Over 5,000 clinicians and caregivers are attending, including surgeons and bariatric physicians, psychologists, nutritionists, nurses and industry stakeholders.  In recognition, Louisiana Governor John Edwards even officially passed a proclamation declaring October 30-November 5, 2016 as “Obesity Care Week” in his state.  Other state and federal policymakers are promoting recognition of obesity as a chronic disease as well.  Healthcare professionals, legislators, patients and families are being asked to view obesity with the same level of seriousness as other chronic medical diseases such as diabetes, heart disease, as well as many common cancers.

So even as we are pouring attention, publicity and healthcare dollars into this problem, we’re still getting stuck, somewhere.  Where do these speedbumps remain?

Science-based treatment is advancing, which will help us get over many hurdles.  Innovative treatment methods such as the Ideal Protein Protocol are becoming widely available as tools for physicians.  The protocol, which I employ in my own practice, specifically targets chronic insulin resistance. We reduce dietary carbohydrates while maintaining adequate protein and healthy fats.  The protocol ameliorates insulin overproduction – the root of Metabolic Syndrome and all its associated problems such as hyperglycemia, hypertension, and hyperlipidemia.  But diet is not enough.   Intensive education on lifestyle modification is also key in this protocol, to ensure that weight loss is maintained in the long term.  Without this comprehensive, ongoing support, it’s impossible for any weight loss protocol to succeed.

Besides education of our patients, education of physicians still remains a significant hurdle.  During my tenure as a Clerkship Director for third-year medical students, I saw not only how faculty clinicians lacked important tools to discuss weight and health, but we are also doing a dismal job teaching future doctors.  In my first oversight of our annual Clinical Skills Exam, I observed one examinee task which was to counsel an obese patient with hyperlipidemia on lifestyle modifications.  It was a shock that out of a class of 65 third-year med students, only six included “lose weight” as part of their counseling plan.  Many students even advised their patients to take statins – hardly lifestyle education in my eyes.  This led to us developing a new mandatory component for the third years at the John A. Burns School of Medicine on “Starting the Conversation” to improve students’ and residents’ comfort levels when discussing their patients’ weight and lifestyle choices.

Among mature physicians, I also find it fascinating that we believe ourselves to be counseling, but patients don’t seem to be hearing the guidance.  A Nielsen Strategic Health Perspectives survey sponsored by the Council of Accountable Physician Practices (CAPP) released in June 2016 highlighted that while 52% of physicians surveyed reported that they recommended weight loss, only 5% of their patients said that they heard this message. As physicians, we must teach and learn that it is critical to clearly, unequivocally, yet gently communicate to our patients our concerns about their health and welfare.  I worry that physicians may not be addressing weight sufficiently because of misguided employed MD bonusing based on patient satisfaction scores (my scores may suffer if I tell patients what they don’t want to hear, right?).   This is not only a shame that physicians may be subtly financially dis-incentivized to communicate openly with patients, it also contributes further to the public health disaster of obesity.  But, when conversations are done in a caring and compassionate manner, I believe we can make inroads.

Formal education of doctors will also be key in this. The American Board of Obesity Medicine (ABOM) aims to educate and certify physicians in comprehensive, science-based obesity care.  This includes an understanding of comprehensive interventions for obesity including diet, behavior change, physical activity, pharmacotherapy, and the care of the bariatric surgical patient.  Certification is not aimed solely at PCPs – any American Board of Medical Specialties member who desires to provide improved care to patients with obesity can certify.   The Obesity Medicine Association’s Medical School Curriculum Committee, of which I’m a member, also aims to educate and to spread awareness.  The central mission of the Committee is to develop a standardized curriculum for US medical schools while promoting awareness of Obesity Medicine as a critical medical specialty.

We physicians must clearly improve how we educate each other, our patients, AND the next generation of clinicians and caregivers.  The coming together of international experts during Obesity Week this year is an absolutely critical step.   Starting and continuing these conversations amongst ourselves will enable us to be far more fluid with our patients and with learners in our field, all while advancing care, treatment, and prevention approaches to this disease.


Linda Anegawa, M.D., F.A.C.P. is the founder of OSR Weight Management-Hawaii Metabolic Medicine.  She serves on the University of Hawaii’s medical school faculty and developed the school’s first Obesity Medicine interdisciplinary clerkship experience.  Dr. Anegawa also sits on the Ideal Protein Medical Advisory Board.