‘We Need to Say That This Is a Crisis’: How CMOs Can Address Obesity

Obesity is a worsening crisis in the United States, according to a recent journal article and the president-elect of the American Academy of Family Physicians (AAFP).

According to the journal article, which was published by The Lancet, nearly three-quarters of the U.S. population aged 25 and older were overweight or obese in 2021. “Without immediate action,” 80% of the adult U.S. population will be overweight or obese by 2050, the journal article’s co-authors wrote.

“Existing policies have failed to address overweight and obesity,” the co-authors wrote. “Without major reform, the forecasted trends will be devastating at the individual and population level, and the associated disease burden and economic costs will continue to escalate.”

There is no question that obesity has reached a crisis point in the United States, according to Sarah Nosal, MD, president-elect of the AAFP and vice president for innovation and optimization as well as chief medical information officer at The Institute for Family Health.

“We need to say that this is a crisis, so we can mobilize the resources that we need,” Nosal says. “Unless we acknowledge this is a crisis across all communities, we will not mobilize resources, and we will not see a change.”

“We are worried about diabetes because it is associated with many other medical problems and diabetes is a chronic disease that can be a burden on its own,” Nosal says. “Once you have diabetes, your likelihood is higher of having stroke, heart attack, vascular complications, amputations, and infections.”

Other serious medical conditions associated with obesity include high cholesterol, cardiovascular disease, sleep apnea, arthritis, and joint pain, according to Nosal.

“Our bodies are built to carry a certain amount of pounds,” Nosal says. “When the amount of pounds that are on our structural system such as our knees is too great, it leads to problems. Many adults are carrying around an extra hundred pounds that joints were not designed to carry.”

How CMOs should address obesity

CMOs of health systems and hospitals need to think about obesity beyond the context of an individual patient in a clinic or hospital setting, according to Nosal.

“You need to think about patients as part of a larger community, and CMOs and others running a hospital system need to think about what health is and the interventions to improve health,” Nosal says. “That may be promoting that fruits and vegetables are available in the community. That may be promoting funding for more walkable communities or more parks access for kids in communities.”

In addition to promoting intensive therapies in clinical settings to make a difference on the individual patient level, CMOs need to think globally about addressing obesity, Nosal explains.

How physicians should address obesity

Nosal, who is a practicing family physician, works with overweight and obese patients on what they want to prioritize.

“Their mother may have diabetes, and they are worried about what they should do,” Nosal says. “I break down what they should do in steps and help them do longitudinal, intensive work.”

Physicians need to help patients manage daily caloric intake and promote consumption of nutritious foods, according to Nosal.

“When you look at the United States and you look around the world,” Nosal says, “all of the countries that have calorie-dense and nutrient-poor foods and a shift to those foods being processed rather than resourced locally have a dramatic shift to overweight and obesity.”

Research has shown that short-term diets are ineffective at addressing overweight and obesity, Nosal explains.

“People need to make long-term changes for the rest of their lives,” Nosal says. “I talk about juice and soda with my patients. Anything that is a liquid calorie is of poor nutritional value.”

A single meal in a restaurant is often more calories than a person should eat in an entire day, according to Nosal.

“That is stunning for most of my patients,” Nosal says. “The assumption is we should be eating multiple meals in a day, but eating out can put us high in caloric intake. I work with my patients to help them understand how much they should be consuming in a day.”

“Research shows people can exercise a few days a week and it can make a difference,” Nosal says. “But exercise by itself has a limited impact on your weight. It is really about the types of calories we are putting in our bodies and how many calories. We should be eating nutrient-rich rather than calorie-rich foods.”