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Introduction

The Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, on April 6, 2017, titled The Challenge of Treating Obesity and Overweight: A Workshop.¹Box 1-1 provides the workshop’s complete Statement of Task; the workshop agenda appears in Appendix A; the acronyms and abbreviations throughout this Proceedings of a Workshop are defined in Appendix B; and the biographies of the speakers and facilitators are provided in Appendix C. Bill Purcell, currently with Farmer Purcell & Lassiter, PLLC, and former mayor of Nashville, Tennessee, introduced the workshop and presented the background on the roundtable. (Box 1-2 provides a brief description of the roundtable.) The discussions covered treatments for obesity, overweight, and severe obesity in adults and children; emerging treatment opportunities; the development of a workforce for obesity treatments; payment and policy considerations; and promising paths to move forward.

It is important to note that this Proceedings of a Workshop summarizes information presented and discussed at the workshop. It is not intended to serve as a comprehensive overview of the subject, nor are the citations herein intended to serve as a comprehensive set of references for any topic;

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¹ The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the rapporteur as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

only references cited on speaker slides are included. The information summarized here reflects the knowledge and opinions of individual workshop participants and should not be seen as a consensus of the workshop; the Roundtable on Obesity Solutions; or the National Academies of Sciences, Engineering, and Medicine.

THE OBESITY EPIDEMIC

In his opening remarks summarizing the dimensions of the obesity epidemic, Purcell observed that obesity is a complex chronic disease characterized by multifaceted considerations and interactions. (Box 1-3 presents Purcell’s summary.) He argued that solutions will require consideration of a wide variety of individual, policy, and environmental factors within a diverse array of settings and with the engagement of a multitude of sectors and leaders that can mobilize needed changes. Like other chronic diseases, he asserted, obesity can be addressed through science-based prevention and treatment approaches. He noted that although the workshop was focused on what is known about treatment, both prevention and treatment are essential to solutions to obesity.

Purcell explained that the planning group for the workshop defined treatment as including all behavioral, pharmacological, and surgical therapies. In so doing, he said, the group acknowledged that definitions of success or effectiveness differ depending on the context of the discussion.

ORGANIZATION OF THIS PROCEEDINGS

This proceedings largely follows the organization of the workshop’s agenda (see Appendix A), although some of the material has been reorganized and some points made in discussion sessions have been incorporated into summaries of presenters’ remarks.

Chapters 2 and 3 provide an overview of what is known about the efficacy of treatments for obesity and overweight in adults and in children and adolescents, respectively, including consideration of lifestyle interventions, pharmacotherapy, and bariatric surgery. Chapters 4 and 5 look at the treatment of severe obesity in adults and in children and adolescents, respectively, from the perspective of obesity medicine specialists, bariatric surgeons, and patients. Chapter 6 describes some emerging opportunities for treating obesity, including new medications, devices, lifestyle interventions, and digital technologies. Chapter 7 considers the development of the workforce for treating obesity, focusing in particular on the competencies that articulate the skills and knowledge that need to be imparted in training this workforce and how those competencies can be incorporated in train-

ing. Chapter 8 looks at the considerations payers take into account when making coverage decisions about obesity treatments, along with ways to expand coverage of treatment. Chapter 9 turns to policy considerations with respect to obesity treatment during a time of heightened debate around health policy. Finally, Chapter 10 addresses the need to involve both communities and individuals in the treatment of obesity.

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