The Four Pillars of Obesity Treatment

Comprehensive Obesity Medicine Care

The OMA endorses a comprehensive, scientific, and individualized approach when treating obesity, which helps patients achieve their health and weight goals. This comprehensive care model is built on the four pillars of obesity treatment: nutrition therapy, physical activity, behavioral modification, medical interventions. Each obesity treatment plan begins with a full assessment and evaluation of the patient. A comprehensive care model for obesity treatment acknowledges the importance of treating the whole person, not just the symptoms.

Nutrition Therapy

Nutrition therapy advocates for dietary options that create a negative caloric balance as a means to attain and sustain a healthy weight. Building this customized, personalized approach to nutrition considers the patient’s level of nutritional knowledge and culinary skills, ensuring that recommendations are both practical and feasible. This healthful approach considers lifestyle, cultural influences, and results from the patient’s assessment and evaluation.

Physical Activity

Physical activity increases metabolism while promoting the body's ability to burn calories efficiently. Additionally, it aids in the development of lean muscle mass, which further contributes to fat burning, as muscles require more energy to maintain. Engaging in cardio exercises and strength training helps improve cardiometabolic health, reducing the risk of obesity-related complications. Importantly, healthcare providers should consider individual limitations and preferences when prescribing exercise by tailoring the program to the patient.

Behavioral Modification

Behavioral modification has a profound influence on obesity treatment by addressing the complex relationship of patients’ psychological and emotional needs. Behavioral modification strategies delve into the habits that contribute to obesity by helping individuals identify and change detrimental patterns. Various behavioral modification techniques such as cognitive-behavioral therapy, mindfulness, and goal setting empower individuals to develop healthier habits and sustain long-term weight management.

Medical Interventions

Medication Management

The OMA recommends patients with obesity have access to evidenced-based, Food and Drug Administration (FDA)-approved anti-obesity medications (AOMs) which must include a comprehensive review of a patient's medications accompanied by a thorough health assessment. Certain medications can cause exacerbation of obesity-related conditions and should be considered for deprescribing based on the obesity medicine clinician's recommendations. The variety of pharmacology options (AOMs) currently available assist in facilitating the patient's eating behaviors, in addition to slowing the progression of weight gain/regain. AOMs offer the potential to improve the health and quality of life for patients with overweight or obesity.

Bariatric Procedures

Metabolic and bariatric surgery and endoscopic procedures are both effective tools in aiding patients with obesity by reducing weight and improving metabolic health. For more information regarding the available surgical and endoscopic options available for patients, please review the 2022 Obesity Pillars® Clinical Practice Statement and the full list of ASMBS endorsed procedures and FDA approved devices.

Complication Management

Particular to obesity-related complications and for any/all associated interventions used to treat obesity (AOMs, bariatric surgery, etc.), such complications must be carefully monitored and facilitated via a therapeutic relationship between patients and their clinicians. As noted in the OMA's Comprehensive Care for Patients with Obesity: An Obesity Medicine Association Position Statement, "treating obesity first" represents a standard of care for patients with complications of obesity.