Integrated Care Model of Adiposity-Related Chronic Diseases

Current Hypertension Reports - Tập 24 - Trang 563-570 - 2022
Thierry H. Le Jemtel1, Rohan Samson1, Suzanne Oparil2
1Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, USA
2Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA

Tóm tắt

Although obesity is a disease, most patients with obesity do not undergo effective treatment nor adhere to long-term care. We examine the barriers that patients with obesity confront when searching for effective treatment and propose an integrated care model of adiposity-related chronic diseases in a cardio-renal metabolic unit. The current care of obesity is fragmented between primary care providers, medical specialists and metabolic bariatric surgeons with little or no coordination of care between these providers. The current care of obesity heavily focuses on weight loss as the primary aim of treatment thereby reenforcing the weight stigma and turning patients away from effective therapy like metabolic bariatric surgery. An interdisciplinary cardio-renal metabolic unit that, besides weight loss, emphasizes prevention/remission of adiposity-related chronic diseases may deliver thorough and rewarding care to most patients with obesity.

Tài liệu tham khảo

Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. State-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381(25):2440–50. Ogden CL, Fryar CD, Martin CB, et al. Trends in obesity prevalence by race and Hispanic origin-1999-2000 to 2017–2018. JAMA. 2020;324(12):1208–10. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523–9. Bays HE, Chapman RH, Grandy S, Group SI. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract. 2007;61(5):737–47. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world–a growing challenge. N Engl J Med. 2007;356(3):213–5. Stenholm S, Head J, Aalto V, et al. Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Obes (Lond). 2017;41(5):769–75. Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280–7. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40–59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7):e1001673. Global Burden of Metabolic Risk Factors for Chronic Diseases C, Lu Y, Hajifathalian K, et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet. 2014;383(9921):970–83. Kyle TK, Dhurandhar EJ, Allison DB. Regarding obesity as a disease: evolving policies and their implications. Endocrinol Metab Clin North Am. 2016;45(3):511–20. Yanovski SZ, Yanovski JA. Progress in Pharmacotherapy for Obesity. JAMA. 2021;326(2):129–30. Burguera B, Schauer P, Kahan S. What to offer the 99% of patients with severe obesity who do not undergo bariatric surgery? Mayo Clin Proc. 2019;94(6):957–60. Mawardi G, Kirkland EB, Zhang J, et al. Patient perception of obesity versus physician documentation of obesity: a quality improvement study. Clin Obes. 2019;9(3): e12303. Lemay CA, Cashman S, Savageau J, Fletcher K, Kinney R, Long-Middleton E. Underdiagnosis of obesity at a community health center. J Am Board Fam Pract. 2003;16(1):14–21. Lumsden RH, Pagidipati NJ, Phelan MP, Chiswell K, Peterson ED. Prevalence and management of adult obesity in a large U.S. academic health system. Am J Prev Med. 2020;58(6):817–24. Pantalone KM, Hobbs TM, Chagin KM, et al. Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system. BMJ Open. 2017;7(11): e017583. McTigue KM, Harris R, Hemphill B, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139(11):933–49. Moyer VA, Force USPST. Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):367–71. Force USPST, Curry SJ, Krist AH, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US preventive services task force recommendation statement. JAMA. 2018;320(11):1163–71. Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959–68. LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: updated evidence report and systematic review for the US preventive services task force. JAMA. 2018;320(11):1172–91. Felix H, West DS, Bursac Z. Impact of USPSTF practice guidelines on clinician weight loss counseling as reported by obese patients. Prev Med. 2008;47(4):394–7. Petrin C, Kahan S, Turner M, Gallagher C, Dietz WH. Current attitudes and practices of obesity counselling by health care providers. Obes Res Clin Pract. 2017;11(3):352–9. Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care. 2013;51(2):186–92. Gero D, Hulesch B, Bueter M. Mindset and Communication Barriers in the Diffusion of Bariatric Surgery. Curr Atheroscler Rep. 2018;20(8):38. Kushner RF, Butsch WS, Kahan S, Machineni S, Cook S, Aronne LJ. Obesity coverage on medical licensing examinations in the United States. What Is Being Tested? Teach Learn Med. 2017;29(2):123–8. Bretches MP, Schwasinger-Schmidt TE. The state of obesity in Kansas: a community based approach to chronic care management. Kans J Med. 2021;14:21–8. Primomo JA, Kajese T, Davis G, et al. Decreased access to bariatric care: an analysis of referral practices to bariatric specialists. Surg Obes Relat Dis. 2016;12(9):1725–30. Tork S, Meister KM, Uebele AL, et al. Factors Influencing Primary Care Physicians' Referral for Bariatric Surgery. JSLS. 2015;19(3). Avidor Y, Still CD, Brunner M, Buchwald JN, Buchwald H. Primary care and subspecialty management of morbid obesity: referral patterns for bariatric surgery. Surg Obes Relat Dis. 2007;3(3):392–407. Glauser TA, Roepke N, Stevenin B, Dubois AM, Ahn SM. Physician knowledge about and perceptions of obesity management. Obes Res Clin Pract. 2015;9(6):573–83. Bray GA, Heisel WE, Afshin A, et al. The science of obesity management: an endocrine society scientific statement. Endocr Rev. 2018;39(2):79–132. •• Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med. 2017;376(3):254–66. A concise and straightforward review of obesity. Elangovan A, Shah R, Smith ZL. Pharmacotherapy for obesity-trends using a population level national database. Obes Surg. 2021;31(3):1105–12. Mauer Y, Parker M, Kashyap SR. Antiobesity drug therapy: an individualized and comprehensive approach. Cleve Clin J Med. 2021;88(8):440–8. Kanj A, Levine D. Overcoming obesity: weight-loss drugs are underused. Cleve Clin J Med. 2020;87(10):602–4. Shi Q, Wang Y, Hao Q, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet. 2022;399(10321):259–69. Boye KS, Lage MJ, Shinde S, Thieu V, Bae JP. Trends in HbA1c and body mass index among individuals with type 2 diabetes: evidence from a US Database 2012–2019. Diabetes Ther. 2021;12(7):2077–87. Fan W, Song Y, Inzucchi SE, et al. Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry. Diabetes Obes Metab. 2019;21(5):1121–7. Puhl RM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003;4(4):213–27. Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity (Silver Spring). 2008;16(5):1129–34. •• Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485–97. The paper underlies the importance of weight stigma in obesity. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984–1010. Piche ME, Tchernof A, Despres JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circ Res. 2020;126(11):1477–500. Boido A, Ceriani V, Cetta F, Lombardi F, Pontiroli AE. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutr Metab Cardiovasc Dis. 2015;25(5):437–43. Chao GF, Diaz A, Ghaferi AA, Dimick JB, Byrnes ME. Understanding racially diverse community member views of obesity stigma and bariatric surgery. Obes Surg. 2022;32(4):1216–26. Cohen R, Newton-John T, Slater A. The case for body positivity on social media: Perspectives on current advances and future directions. J Health Psychol. 2021;26(13):2365–73. Muttarak R. Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England. Obesity (Silver Spring). 2018;26(7):1125–9. Penney TL, Kirk SF. The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. Am J Public Health. 2015;105(5):e38-42. Verhaak AMS, Ferrand J, Puhl RM, Tishler DS, Papasavas PK, Umashanker D. Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample. Int J Obes (Lond). 2022. Ricci MA, De Vuono S, Scavizzi M, Gentili A, Lupattelli G. Facing Morbid Obesity: How to Approach It. Angiology. 2016;67(4):391–7. Campos GM, Khoraki J, Browning MG, Pessoa BM, Mazzini GS, Wolfe L. Changes in utilization of bariatric surgery in the United States from 1993 to 2016. Ann Surg. 2020;271(2):201–9. Zevin B, Dalgarno N, Martin M, et al. Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary care: a qualitative study. CMAJ Open. 2019;7(4):E738–44. Barber D, Morkem R, Dalgarno N, et al. Patients eligible and referred for bariatric surgery in southeastern Ontario: retrospective cohort study. Can Fam Physician. 2021;67(1):e31–40. Lopez EKH, Helm MC, Gould JC, Lak KL. Primary care providers’ attitudes and knowledge of bariatric surgery. Surg Endosc. 2020;34(5):2273–8. Funk LM, Jolles SA, Greenberg CC, et al. Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study. Surg Obes Relat Dis. 2016;12(4):893–901. Imbus JR, Voils CI, Funk LM. Bariatric surgery barriers: a review using Andersen’s Model of Health Services Use. Surg Obes Relat Dis. 2018;14(3):404–12. Dolan P, Afaneh C, Symer M, Dakin GF, Pomp A, Yeo H. Assessment of public attitudes toward weight loss surgery in the United States. JAMA Surg. 2019;154(3):264–6. Pearl RL, Wadden TA, Walton K, Allison KC, Tronieri JS, Williams NN. Health and appearance: Factors motivating the decision to seek bariatric surgery. Surg Obes Relat Dis. 2019;15(4):636–42. Zevin B, Martin M, Dalgarno N, et al. Survey of perceptions and educational needs of primary care providers regarding management of patients with class II and III obesity in Ontario, Canada. BMC Fam Pract. 2021;22(1):14. van Veldhuisen SL, Gorter TM, van Woerden G, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J. 2022;43(20):1955–69. Bramante C, Wise E, Chaudhry Z. Care of the patient after metabolic and bariatric surgery. Ann Intern Med. 2022;175(5):ITC65-ITC80. Altieri MS, Irish W, Pories WJ, Shah A, DeMaria EJ. Examining the rates of obesity and bariatric surgery in the United States. Obes Surg. 2021;31(11):4754–60. Hanipah ZN, Schauer PR. Bariatric surgery as a long-term treatment for type 2 diabetes/metabolic syndrome. Annu Rev Med. 2020;71:1–15. Pareek M, Bhatt DL, Schiavon CA, Schauer PR. Metabolic Surgery for Hypertension in Patients With Obesity. Circ Res. 2019;124(7):1009–24. Morgan DJ, Ho KM, Armstrong J, Litton E. Long-term clinical outcomes and health care utilization after bariatric surgery: a population-based study. Ann Surg. 2015;262(1):86–92. Canner JK, Kaslow SR, Gani F, et al. Incidence of and risk factors associated with care fragmentation following bariatric surgery. Surg Obes Relat Dis. 2019;15(7):1170–81. Lazzati A, Chatellier G, Paolino L, Batahei S, Katsahian S. Postoperative care fragmentation in bariatric surgery and risk of mortality: a nationwide study. Surg Obes Relat Dis. 2021;17(7):1327–33. El Chaar M. How can we shape our future as bariatric surgeons and win the fight against obesity in an ever-changing healthcare industry? Surg Obes Relat Dis. 2021;17(2):466–8. Tsai AG, Bessesen DH. Obesity. Ann Intern Med. 2019;170(5):ITC33-ITC48. Haskins IN. Comment on: emergency department encounters, hospital admissions, course of treatment, and follow-up care for behavioral health concerns in patients after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2021;17(10):e50–1. Hua Y, Lou YX, Li C, Sun JY, Sun W, Kong XQ. Clinical outcomes of bariatric surgery - Updated evidence. Obes Res Clin Pract. 2022;16(1):1–9. Hall JE, Mouton AJ, da Silva AA, et al. Obesity, kidney dysfunction, and inflammation: interactions in hypertension. Cardiovasc Res. 2021;117(8):1859–76. Larjani S, Spivak I, Hao Guo M, et al. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery. Surg Obes Relat Dis. 2016;12(2):350–6. Shibuya K, Ji X, Pfoh ER, et al. Association between shared medical appointments and weight loss outcomes and anti-obesity medication use in patients with obesity. Obes Sci Pract. 2020;6(3):247–54. Reiter-Brennan C, Dzaye O, Davis D, Blaha M, Eckel RH. Comprehensive care models for cardiometabolic disease. Curr Cardiol Rep. 2021;23(3):22. Rives-Lange C, Rassy N, Carette C, et al. Seventy years of bariatric surgery: a systematic mapping review of randomized controlled trials. Obes Rev. 2022;23(5): e13420. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641–51. Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2021;397(10271):293–304. Courcoulas AP, Gallagher JW, Neiberg RH, et al. Bariatric surgery vs lifestyle intervention for diabetes treatment: 5-year outcomes from a randomized trial. J Clin Endocrinol Metab. 2020;105(3). Schiavon CA, Bhatt DL, Ikeoka D, et al. Three-year outcomes of bariatric surgery in patients with obesity and hypertension : a randomized clinical trial. Ann Intern Med. 2020;173(9):685–93. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021;397(10287):1830–41. Mentias A, Aminian A, Youssef D, et al. Long-term cardiovascular outcomes after bariatric surgery in the medicare population. J Am Coll Cardiol. 2022;79(15):1429–37. Bouchard P, Al-Masrouri S, Demyttenaere S, Court O, Andalib A. Long-term impact of bariatric surgery on major adverse cardiovascular events in patients with obesity, diabetes and hypertension: a population-level study. Obes Surg. 2022;32(3):771–8. Schauer PR, Nissen SE. After 70 years, metabolic surgery has earned a cardiovascular outcome trial. Circulation. 2021;143(15):1481–3. Cypess AM. Reassessing human adipose tissue. N Engl J Med. 2022;386(8):768–79. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14(3):160–9. Pareek M, Schauer PR, Kaplan LM, Leiter LA, Rubino F, Bhatt DL. Metabolic surgery: weight loss, diabetes, and beyond. J Am Coll Cardiol. 2018;71(6):670–87. Jimenez A, Pane A, Ibarzabal A, et al. Weight-loss thresholds after bariatric surgery and cardiovascular outcomes: more is better. Int J Obes (Lond). 2022;46(2):279–86. Muller TD, Bluher M, Tschop MH, DiMarchi RD. Anti-obesity drug discovery: advances and challenges. Nat Rev Drug Discov. 2022;21(3):201–23. Goncalves E, Bell DSH. Combination treatment of SGLT2 inhibitors and GLP-1 receptor agonists: symbiotic effects on metabolism and cardiorenal risk. Diabetes Ther. 2018;9(3):919–26. •• Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022. The findings of Tirzepatide randomized controlled trial. Laferrere B, Pattou F. Weight-independent mechanisms of glucose control after Roux-en-Y gastric bypass. Front Endocrinol (Lausanne). 2018;9:530. Cummings DE, Rubino F. Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia. 2018;61(2):257–64. Lawler H, Salehi M. Diabetes Remission After Gastric Bypass: To Be or Not to Be Dependent on Weight Loss. J Clin Endocrinol Metab. 2021;106(5):e2362–4. Samson R, Milligan G, Lewine E, et al. Effect of sleeve gastrectomy on hypertension. J Am Soc Hypertens. 2018;12(11):e19–25. •• Aminian A, Zajichek A, Tu C, et al. How much weight loss is required for cardiovascular benefits? Insights from a metabolic surgery matched-cohort study. Ann Surg. 2020;272(4):639–45. An important discussion of relationship between weight loss and health improvement. Prospective Studies C, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96. Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol. 2018;6(12):944–53. d’Errico M, Pavlova M, Spandonaro F. The economic burden of obesity in Italy: a cost-of-illness study. Eur J Health Econ. 2022;23(2):177–92. Saxon DR, Reiter-Brennan C, Blaha MJ, Eckel RH. Cardiometabolic medicine: development of a new subspecialty. J Clin Endocrinol Metab. 2020;105(7). •• Bluher M. Metabolically healthy obesity. Endocr Rev. 2020;41(3). A seminal review of metabolically healthy and unhealthy obesity. Magkos F. Metabolically healthy obesity: what’s in a name? Am J Clin Nutr. 2019;110(3):533–9. Roberson LL, Aneni EC, Maziak W, et al. Beyond BMI: The “Metabolically healthy obese” phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality – a systematic review. BMC Public Health. 2014;14:14. Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: a systematic review and meta-analysis. Ann Intern Med. 2013;159(11):758–69. Lehn-Stefan A, Peter A, Machann J, et al. Impaired metabolic health and low cardiorespiratory fitness independently associate with subclinical atherosclerosis in obesity. J Clin Endocrinol Metab. 2022;107(6):e2417–24. Stefan N, Haring HU, Cusi K. Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies. Lancet Diabetes Endocrinol. 2019;7(4):313–24. Boonchaya-anant P, Apovian CM. Metabolically healthy obesity–does it exist? Curr Atheroscler Rep. 2014;16(10):441. Palau-Rodriguez M, Garcia-Aloy M, Minarro A, et al. Effects of a long-term lifestyle intervention on metabolically healthy women with obesity: metabolite profiles according to weight loss response. Clin Nutr. 2020;39(1):215–24. Kantartzis K, Machann J, Schick F, et al. Effects of a lifestyle intervention in metabolically benign and malign obesity. Diabetologia. 2011;54(4):864–8. Mehta M, Istfan NW, Apovian CM. Obesity: overview of weight management. Endocr Pract. 2021;27(6):626–35. Cambi MPC, Baretta GAP, Magro DO, et al. Multidisciplinary approach for weight regain-how to manage this challenging condition: an expert review. Obes Surg. 2021;31(3):1290–303. O’Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14. Coelho C, Crane J, Agius R, McGowan B. The bariatric-metabolic physician’s role in managing clinically severe obesity. Curr Obes Rep. 2021;10(3):263–73. Gasmi A, Bjorklund G, Mujawdiya PK, et al. Micronutrients deficiences in patients after bariatric surgery. Eur J Nutr. 2022;61(1):55–67.