17th annual Global Forum discusses meeting the needs of patients with obesity

On April 18, 2024, ACP held its 17th annual Global Forum in Boston on “Meeting the Needs of Patients With Obesity: Policy, Prevention, and Treatment.” Panelists, attendees, and ACP leadership discussed the challenges of obesity care worldwide and discussed what professional societies, individual physicians, and governments can do to address prevention.

The forum was moderated by Omar T. Atiq, ACP President, and Eileen Barrett, Chair of the Board of Regents, with four panelists representing the Faculty of Consulting Physicians of South Africa, the Royal College of Physicians, the Latin American Society of Internal Medicine, and the ACP Japan Chapter.

Dr. Atiq welcomed the forum participants and led introductions of internal medicine society leadership and the Executive Committee of the ACP's Board of Regents, including Dr. Barrett; Darilyn V. Moyer, ACP's Executive Vice President and Chief Executive Officer; and Mukta Panda, Chair of the Global Engagement Committee.

Dr. Atiq started the discussion, outlining the four discussion questions to be debated by the panel and by the audience: 1) What lessons can resource-rich health systems learn from other health systems in more resource-limited settings about preventing and treating patients with obesity? 2) In what ways can professional societies provide education to physicians about evidence-based policy on preventing and treating obesity? 3) How can organizations partner with other organizations, communities, or governments to better meet the needs of patients with obesity? 4) What are the ways that organizations can support members participating in advocacy around preventing obesity?

The Forum proceeded with a distinguished panel of international physicians:

• Frederik Bester, President of the Faculty of Consulting Physicians of South Africa
• Sarah Clarke, President of the Royal College of Physicians
• Lorenzo Diaz Salazar, President of the Latin American Society of Internal Medicine
• Harumi Gomi, Governor for ACP's Japan Chapter and member of the Global Engagement Committee

Dr. Bester kicked off the discussion by noting that Africa is a very young continent and that rapid urbanization and Westernization over the next two decades will likely result in increases in obesity. In some countries, the prevalence of obesity is already in the region of 20% for adults and 10% for children.

“With a growing middle class who prefer high-energy processed food, rich in sugar, because this is the more affordable food on the continent, obesity is just getting worse and worse,” Dr. Bester said. He explained that Africa is battling other diseases, such as tuberculosis, HIV, malaria, and Ebola, and that political systems are also unstable, “so obesity on the continent is really on the back burner,” despite the fact that it is becoming an epidemic.

Regarding solutions, Dr. Bester said that countries with scarce resources must emphasize prevention and lifestyle modification rather than rely on expensive medications. Multifaceted educational campaigns that encompass the political and economic arenas as well as the health arenas will be key, he stressed.

Dr. Bester called for organizations like ACP and key opinion leaders in the medical profession globally to develop dedicated action groups and give scientific guidance to these efforts and for the harnessing of social media to spread the message about obesity and healthy lifestyles.

Dr. Clarke then explained that obesity is one of the U.K.'s most pressing public health challenges, with more than one million National Health Services admissions with obesity as a factor in 2019-2020. She described how the Royal College of Physicians' Inequalities in Health Alliance is campaigning for a cross-government strategy to reduce health inequalities.

“We know that a range of factors, including the food we eat and can afford, have an impact on our health. The causes of obesity are complex,” Dr. Clarke said. “It's a multifactorial condition that is a result of biological, genetic, and social factors and requires a multifactorial solution.”

She noted that a cross-government strategy to reduce health inequalities should recognize the role of excess weight and that preventing as many people as possible from developing overweight and obesity is paramount, adding that access to weight management services and obesity drugs must go hand in hand with robust prevention policies, such as restrictions on the advertising of foods that are high in fat, salt, and sugar.

The Royal College of Physicians has called for a national obesity prescription for England that includes national delivery of effective weight-management interventions to prevent people developing serious illnesses, Dr. Clarke said. In addition, “we should recognize that obesity is a disease,” she said. “We've called for obesity to be urgently recognized as a disease by the government and the broader health sector.”

Dr. Diaz Salazar described current conditions in Latin America, which is experiencing a period of low economic growth, severe climatic phenomena, unstable modes of food production, and demographic movement. He noted that while food insecurity is common, overweight and obesity are as well, and that safety concerns limit outside exercise.

More resource-rich countries could learn from Latin America's holistic approach, Dr. Diaz Salazar said. Community outreach and multisectoral collaborations are key, he explained. “The system of education and the system of health in the community, it works together,” he said.

Dr. Gomi relayed that all citizens and legal residents in Japan have health care coverage and are required to have annual checkups, including screening for the metabolic syndrome with body mass index, blood pressure, glucose, and hemoglobin A1c. Those with abnormal results can receive free consultation with a nurse or free dietary consultation through the local department of health, with referral to a physician as needed, she said.

Regarding prevention, Dr. Gomi explained that the government has been proactive in underscoring early screening for obesity and noted that most restaurants offer calorie information on their menus. Opportunities for improvement include having better networking between the Ministry of Health and academic societies such as the Japanese Society of Internal Medicine and ACP's Japan Chapter to develop evidence-based strategies for the general public, she said.

After the panelists spoke, Dr. Barrett opened the floor to questions and comments from other attendees.

Irma Luisa Ceja Martinez, a member of ACP's Global Engagement Committee, described a new government initiative in Mexico that involves labeling all food that has excess salt, sugar, or fat with black diamonds. “Of course a lot of people hate these diamonds, but one of the things that you actually do when you have your patients, you actually do tell them, ‘OK, if this has three diamonds, look away,’” she said. Even if patients don't agree immediately, she said, it becomes a conscious decision whether or not to buy these types of foods.

Another initiative under way is taking more care with words, Dr. Ceja Martinez explained. “We have stopped trying to combine, ‘OK, all the people that have obesity, it's because they're sedentary, or because they lack willpower,’” she said. Explaining obesity to patients as a multifactorial problem may help them feel more comfortable discussing weight and weight loss with their physicians, she noted.

A. Muruganathan, a member of ACP's Global Engagement Committee, described the close collaboration in India between each town's physicians' association and school association, including counseling for children with obesity. Natalie Maynard Gamboa, Vice President of the Association of Internal Medicine of Costa Rica, described how obesity medications in Costa Rica are available only to private payers and how most patients do not have access to nutritionists or physical therapists. She also echoed Dr. Diaz Salazar's point about safety, stressing that outdoor exercise is often not an option, and said that economic considerations also play a role, since many people work multiple jobs and lack time and energy for exercise.

Suranga Manilgama, President of the Sri Lanka College of Internal Medicine, noted that two-thirds of people in Sri Lanka have overweight or obesity, according to recent statistics, and said sudden urbanization has increased the availability of unhealthy food. One solution is working to develop a public portal to provide information on healthy lifestyles and behavior in Sinhala, Tamil, and English, Dr. Manilgama explained.

Everard N. Barton, Governor for ACP's Caribbean Chapter, stressed the importance of starting the conversation early and educating families at prenatal and antenatal clinics. Dr. Diaz Salazar called for additional promotion of stigma-free care and asked ACP to work with the media, schools, and community influencers to combat the stigma surrounding obesity. Dr. Moyer discussed ACP's resources on obesity, including patient pages in Annals of Internal Medicine's In the Clinic section and ACP's Obesity Management Learning Hub. She also noted that ACP's Clinical Guidelines Committee is currently reviewing evidence on pharmacological treatment of obesity.

Ogochukwu Chinedum Okoye, a Global Physician Scholar, brought up the importance of social media and helping to promote education through influencers. Ricardo Gómez Huelgas, President of the European Federation of Internal Medicine, said that it's not enough to say that obesity is a chronic disease. “When we are talking about a disease with a global prevalence of 40%, 50% of overweight or obesity, it's not only a disease, it's a social disease,” he said. “So something is wrong in our society, something's wrong in our lifestyle, when we reach this kind of prevalence.”

Dr. Gómez Huelgas called for prioritization of prevention measures and said that professional scientific societies have a responsibility to push politicians to change policies on everything from infrastructure to workplaces. “Don't forget that obesity is a good marker of low incomes, low educational levels, so we have to commit against the inequities in the social and economical and educational point of view,” he said.

Priya Radhakrishnan, Chair of ACP's Board of Governors, discussed opportunities for artificial intelligence in combating obesity but noted that a balance must be maintained between privacy and intervention. Future work will involve both predictive modeling and patient engagement, she said.

Datuk Seri Dr Paras Doshi, President of the College of Physicians Malaysia, stressed the importance of education so that patients can begin distinguishing between foods with low and high glycemic indices. Dr. Paras Doshi noted that obesity often runs in the family and that interventions must target everyone, not just one member. He also mentioned the importance of social media, particularly TikTok, and using physicians to disseminate accurate information about obesity.

Dr. Ceja Martinez brought up the contribution of emotional eating to obesity, especially in communities with high levels of intimate partner violence, and said that this factor must be addressed in any potential solutions. Hany Eteiba, President-elect of the Royal College of Physicians and Surgeons of Glasgow, noted that policymakers may not always have the best interests of the population at heart and said that reforms are needed for both taxation and investment. He also stressed the need for more education in primary care and more attention to obesity management as a target measure.

Steven Shadowitz, President of the Canadian Society of Internal Medicine, called for those in attendance to train other physicians to be advocates in this area and challenged them to make obesity a focus of their organizations' national meetings. He also stated his belief that the problem of obesity will only be solved through comprehensive primary care for all.

Dr. Barrett asked attendees to give examples of how their organizations are working with members on this issue in terms of advocacy and education. Dr. Clarke described how the Royal College of Physicians is working to reach every member and communicate the importance of addressing obesity through changes in policy, and Francis Fusumada explained how ACP's Central America Chapter has advocated for nutritional screening and education for all patients.

Dr. Atiq closed the forum by discussing ACP's New Vision for the U.S. Health Care System, a series of position papers published as a supplement to Annals of Internal Medicine in 2021, noting that they cover education, healthy food, accessibility of health care, and mental health, among other topics.

“We as an organization have gone from being an internal medicine organization, which we still are and will always be, towards trying to make sure that there's health, because we can't treat obesity or any other illness by itself,” Dr. Atiq said. “It has to be a holistic approach. … You can't talk about treating illnesses if you don't talk about trying to take care of the human being who has illnesses with education, starting from the very basics.”

Dr. Atiq thanked the panelists and attendees and encouraged them to continue sharing their ideas on how to combat obesity. “This has been a remarkable, fascinating discussion,” he said. “Not just has it been about obesity, but to me it has been about how to manage our health.”

The 2025 Forum will be held on Thursday, April 2, at Internal Medicine Meeting 2025 in New Orleans. More information about the meeting is online.