ACP paper calls on policymakers to improve obesity treatment access and affordability

In a new position paper, the American College of Physicians (ACP) has issued several recommendations on how policymakers can increase accessibility of obesity treatment for adults and address modifiable factors that contribute to obesity like diet and physical activity. The paper also includes further recommendations on reducing stigma associated with obesity, improving understanding of obesity among physicians and increasing access to healthy food.

According to research from the CDC, forty percent of US adults have obesity, a complex condition determined by modifiable and nonmodifiable factors such as genetics, behaviour, and environment. Obesity is associated with certain comorbidities including type 2 diabetes, high cholesterol, sleep apnoea, some cancers and may increase the severity of communicable diseases. Obesity treatments include pharmacotherapy, behavioural modification and surgical procedures, but high cost, coverage restrictions and geographic access to care are a substantial barrier for many patients.

According to the ACP, the complexity of this condition demands a comprehensive, multisector response. ACP explores obesity among US adults, outlines factors that contribute to high obesity rates, discusses coverage of available medical treatments and prevention-focused population-based interventions and issues recommendations for policy changes that would lower the rate of obesity.

“Physicians are on the front lines of treating patients with obesity, a serious, high-risk condition that has significant prevalence in the U.S. With rates of obesity steadily rising, it is crucial for policymakers to help health care professionals by enacting system-wide changes that contribute to obesity, including behavioural, metabolic and environmental factors,” said Dr Jan K Carney, president, ACP. “ACP has issued recommendations that would amend current policies and procedures and introduce concrete change to the current public health landscape and clinical practice.”

The paper issues the following recommendations to address obesity as a medical condition, reduce stigma, and improve understanding of obesity among physicians.

Healthcare sector policies

ACP recommends that all payers cover a consistent comprehensive package of evidence-based obesity interventions including obesity prevention and screening services, intensive lifestyle treatment, pharmacologic treatments and weight loss surgery. ACP supports efforts to expand access to nutritious foods through evidence-based prescription food programs and supports sufficient reimbursement for physician-led team-based care models to prevent, diagnose and manage obesity. ACP also supports initiatives to reduce bias and stigma associated with obesity and larger body sizes and recommends that medical students and physicians should receive training in nutrition and the prevention, screening and treatment of obesity.

Agriculture and nutrition policies

ACP recommends policies should expand access to affordable nutritious foods through measures such as sufficient funding for federal food and nutrition assistance programs, cultivating whole food specialty plant crops, and encouraging nutritious foods in health care settings while limiting the sale of unhealthy items. ACP recommends the development of a formal, evidence-based definition of and appropriate restrictions on ultra-processed foods. Federal dietary guidelines should be based on sound scientific evidence. ACP supports efforts to educate the public about healthy eating, including through effective food labels and educational resources derived from evidence-based dietary guidelines free of undue industry influence.

Built environment, planning and transportation activities

ACP recommends community planning and built environment policies that encourage safe, zero- and low-emission active transportation, such as pedestrian- and bicycle-friendly infrastructure, and safe physical activity. Planning should consider all communities, including low-income and historically marginalized areas that have limited access to green space.

Research

Finally, ACP supports robust obesity research and sufficient funding and staffing for federal research agencies to better understand the origins behind obesity in adults, the effects of ultra-processed food consumption, ways to achieve equitable care for adults with obesity and best practices in obesity screening and treatment.

The findings were published in the paper, ' Public Policy Approaches to Addressing Adult Obesity: A Position Paper from the American College of Physicians', published in the Annals of Internal Medicine. To access this paper, please click here