Overweight and Obesity: One Expert's 3 Wishes for the Future of Patient Care

"Obesity is excess abnormal body fat that affects your health. It's not just BMI. It's not just body size."

When asked what her 3 wishes would be for the future of patient care in weight management, Donna Ryan, MD, told Patient Care^© Online that first and foremost she wished that everyone would understand that obesity is a serious chronic disease. And "everyone" includes health care providers, patients, average citizens, society at large.

Watch our short interview to hear her other 2 wishes, a 4th one she added, and her message for primary care clinicians who are treating patients with overweight or obesity.

Donna H Ryan, MD, is professor emerita at the Pennington Biomedical Research Center in Baton Rouge, LA, and immediate past president of the World Obesity Federation. She directed clinical research for 22 years at Pennington Biomedical and her own research encompasses key roles in the DASH (Dietary Approaches to Stop Hypertension), POUNDS Lost, DPP (Diabetes Prevention Program) and Look AHEAD studies. Ryan's continuing research interests focus on translation of effective weight management into primary care practices.

The following transcript has been lightly edited for clarity and style.

Patient Care Online. If you were granted three wishes for the future of patient care in chronic weight management, let's say over the next 10 to 15 years, what would those three wishes be?

Donna Ryan, MD. I think my number-one wish would be that people understand what obesity is. The clinical definition for a diagnosis of obesity is excess abnormal body fat that affects your health. It's not just a BMI. It's not just body size. I think if people understood that we make the diagnosis of obesity, not just from BMI, but also with a health assessment. It’s about where that body fat is, and how it's affecting health. So that would solve a lot of problems and discussion when people say, “Oh, I'm perfectly healthy, even though my BMI is high.” That may be true. What we're talking about when we talk about obesity is people who have health problems, because of excess abnormal body fat. We need to recognize it's a clinical diagnosis, and we know how to make it. And we need to take it seriously, when people have access abnormal body fat that's affecting their health. So, number one, let's all understand what obesity is, and that it is a serious chronic disease. I think if everyone would get on board with that wish, my other wishes would fall in line.

My number two wish would be that we would continue developing effective treatments for people with obesity, and, number three, that people with obesity will have access to those treatments. All the wonderful treatments in the world don't help us if we don't have payers who will pay to help us get access to these treatments. So, my three wishes: Let's get some good treatments and we’re well on the way there. And let's get access to these treatments.

Can I have four? Okay, my fourth wish. I think that as a society, we really need to do the hard work of addressing our obesogenic environment; we need to address our food environment. And we need to address our physical activity environment. And this really takes a multipronged approach and a lot of political will. Because we really need to do this to prevent obesity, to prevent obesity in our children, because it's just carrying on over into adulthood.

PCO: Is there anything I might not have covered that you would like to offer to primary care about weight management?

Ryan. You know, I think the primary care doctors have such an important role in in addressing obesity, and it's not just the doctors, it’s the nurse practitioners and our physician's assistants. It’s really everybody in that primary care office. Primary care needs to be a safe place for patients with obesity where they don't feel stigmatized, where they know that they're being treated for a disease. They're not being blamed for their body size and that it's such a difficult task for primary care to address this, but the doctors and nurses and health care professionals I know in that space, do a good job so keep it up.

PCO: Thank you so much