Obesity Management Phases: Initiation, Response, and Maintenance

Hi, I'm Dr. Mick Crotty, a GP and obesity medicine specialist based in Dublin, Ireland.

Obesity is a chronic, progressive and relapsing disease that requires long-term treatment and care. In this context, healthcare professionals and patients should recognize and address three key phases of obesity care. Initiation, response, and maintenance.

Each of these presents unique challenges and opportunities for improving health and quality of life.

The initiation phase in an obesity management care plan involves assessment, shared understanding of obesity as a chronic disease, collaborative decision-making, and addressing expectations before starting treatment. Patients living with obesity face several well-documented barriers to initiating treatment, which can include weight stigma and obesity treatment stigma, lack of recognition of obesity as a chronic disease, response to previous weight management strategies, limited access to specialized care and cost concerns, as well as cultural and social norms.

In a recent study, we found that patients' decision-making when it comes to selecting an obesity medication is multidimensional and influenced by the medications effectiveness, which can go beyond just weight reduction, the information they have about the medication, which may come from their GP, peers or social media, medication safety in terms of side effects and long term safety, and practical considerations such as affordability, supply, ease of use, and the support that they have to implement this treatment in the context of their life circumstances.

The response phase in obesity management care focuses on monitoring the patient's progress, gradual dose titration, supporting patients navigating adverse effects, and evaluating clinical response, such as changes in appetite, weight change, noticing quality, not just quantity of weight change, as well as focusing on quality of life and improvements in metabolic, mechanical, and psychosocial health. This requires regular follow-up and individualized care as early response is a strong predictor of long-term outcomes. For patients on pharmacotherapy or other interventions, side effects are tracked and managed to ensure continued adherence and safety.

Based on early treatment response, the care team may need to intensify interventions by modifying medical nutrition therapy or physical activity plans, introducing or changing obesity medications, referring for behavioral therapy or specialist services, as well as considering surgical intervention. Lack of response may trigger re-evaluation of barriers or alternative strategies. The maintenance phase in obesity care plans focuses on weight maintenance and health improvements over the long term, through continued medical, nutritional, behavioral and psychological support as well as regular follow-up. Obesity requires long-term treatment like any other chronic disease. Sharing an understanding with patients that weight stabilization occurs with all treatments and, although it may or may not align with their expectations, it usually coincides with health benefits. A modest reduction in weight, let's say 5-10%, is associated with long-term health gain. Communication during this phase should emphasize health improvements, not just weight reduction. In addition to health, a person's symptoms, lived experience and expectations can change over time. Fluctuations in appetite are common, and this may concern our patients, although it may or may not be associated with significant weight change. Highlighting the evolving nature of care and maintaining engagement is vital to to support our patients. Obesity relapse prevention strategies focus on identifying signs of disease recurrence. Patients may need to adapt their obesity treatment routines to evolving life circumstances, medical, or psychosocial factors, which support for self-efficacy and resilience. Ongoing obesity care is necessary to maintain health outcomes, as stopping treatment leads to disease recurrence. Recognizing and addressing the initiation, response, and maintenance phases in an obesity care plan is essential for delivering effective, individualized, and sustainable treatment, ensuring that patients receive ongoing support tailored to the evolving nature of their chronic relapsing disease.

I'm Dr. Mick Crotty for 5-Minute CPD. Thanks for watching. Be sure to check out additional resources on this page and more learning at easo.org.