Kane Ryan M, Nicklas Jacinda M, Schwartz Jessica L, Bramante Carolyn T, Yancy William S, Gudzune Kimberly A, Jay Melanie R
Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
Clinical and Translational Science Institute, Duke University, Durham, NC, USA.
J Gen Intern Med. 2024 Oct 16. doi: 10.1007/s11606-024-09084-z.
The number and complexity of obesity treatments has increased rapidly in recent years. This is driven by the approval of new anti-obesity medications (AOMs) that produce larger degrees of weight loss than previously approved AOMs. Unfortunately, access to these highly effective therapies and to integrated team-based obesity care is limited by intra-/interpersonal patient, institutional/practitioner, community, and policy factors. We contextualized these complexities and the impact of patients' social drivers of health (SDOH) by adapting the social ecological model for obesity. Without multi-level intervention, these barriers to care will deepen the existing inequities in obesity prevalence and treatment outcomes among historically underserved communities. As General Internal Medicine (GIM) physicians, we can help our patients navigate the complexities of evidence-based obesity treatments. As care team leaders, GIM physicians are well-positioned to (1) improve education for trainees and practitioners, (2) address healthcare-associated weight stigma, (3) advocate for equity in treatment accessibility, and (4) coordinate interdisciplinary teams around non-traditional models of care focused on upstream (e.g., policy changes, insurance coverage, health system culture change, medical education requirements) and downstream (e.g., evidence-based weight management didactics for trainees, using non-stigmatizing language with patients, developing interdisciplinary weight management clinics) strategies to promote optimal obesity care for all patients.
近年来，肥胖治疗的数量和复杂性迅速增加。这是由新的抗肥胖药物（AOMs）的获批推动的，这些药物比先前获批的AOMs能带来更大程度的体重减轻。不幸的是，患者个体/人际、机构/从业者、社区和政策因素限制了获得这些高效治疗方法以及基于团队的综合肥胖护理的机会。我们通过调整肥胖的社会生态模型，将这些复杂性以及患者健康的社会驱动因素（SDOH）的影响置于具体情境中。如果没有多层次干预，这些护理障碍将加深历史上服务不足社区在肥胖患病率和治疗结果方面现有的不平等。作为普通内科（GIM）医生，我们可以帮助患者应对循证肥胖治疗的复杂性。作为护理团队的领导者，GIM医生有能力（1）改善对实习生和从业者的教育，（2）解决与医疗保健相关的体重歧视问题，（3）倡导治疗可及性方面的公平，以及（4）围绕专注于上游（如政策变化、保险覆盖、卫生系统文化变革、医学教育要求）和下游（如为实习生提供循证体重管理教学、与患者使用无歧视性语言、建立跨学科体重管理诊所）策略的非传统护理模式协调跨学科团队，以促进为所有患者提供最佳的肥胖护理。
