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Breaking the Vicious Cycle of Obesity

Achieving Total Person Health

lines of health care terms with obesity highlighted in yellow

People set New Year’s resolutions to lose weight. They don’t plan for it, or they don’t plan well for it. They may or may not lose weight, and they frequently gain the weight back if they do lose it. Sometimes they gain back even more weight than they lost. They feel frustrated. They feel disappointed. Then the next year comes around - or a birthday, or a reunion, or a trip, or a health scare - and they set another resolution to lose weight. They don’t plan for it, or they don’t plan well for it. They may or may not lose weight, and they feel frustrated. They feel disappointed. Next time, they feel hopeless. They feel helpless. They feel resigned. This is the vicious cycle of weight loss/weight gain that people experience. It is a plight that so many people know all too well. It can lead to despair, immobilization, and desperation. This vicious cycle, and obesity itself, has an immeasurable impact on the physical and mental health of people.

The Centers for Disease Control and Prevention most recently reported that the obesity prevalence in the United States has dramatically increased to 41.9%.

Obesity is a chronic and debilitating disease that is estimated to continue to increase in prevalence to nearly 50% of adults by 2030, according to a 2019 study published in the New England Journal of Medicine. Research has reliably and overwhelmingly shown that obesity is associated with increased risk for mortality and significant health conditions including type 2 diabetes, hypertension, coronary artery disease and many others. The cost of healthcare for obese individuals is a multiple of the non-obese.

chart of obesity related co-morbidites

Studies have also shown an association between obesity and mental health issues. With such serious implications and concern about the negative effects of being overweight or obese, it is not a surprise that surveys consistently reveal that over 40% of people try to lose weight within any given year. Yet so few people are successful at losing weight, maintaining weight loss, and thwarting the deleterious effects.

Moving Beyond the Usual Approach

The usual weight loss interventions provide good educational content and easy accountability, typically in a digital format, focused on attracting the more motivated individuals to self-engage. The striking issue with these usual weight loss interventions is that they are ineffective at engaging the very population that is in most need to lose significant weight, the struggling less motivated. For example, many typical lifestyle interventions for obesity focus primarily on providing education to passive recipients of this information. Other lifestyle interventions direct people to resources such as mobile apps that individuals are then expected to access and digest on their own. And when supplementary interventions are included (e.g., medication, remote monitoring devices), patients are frequently assumed to be motivated and the associated lifestyle interventions again rely mostly on one-way, verbal education by the provider or self-directedness by the patient.

overweight man sitting and talking to his doctor

Given that so many people struggle with weight loss, we must be better than these usual interventions to truly impact obesity and lives. Most patients are not highly motivated. Remember the vicious cycle? People want to lose weight and try. They are not successful. They feel frustrated, disappointed. They try again and aren’t successful. They feel hopeless, helpless, resigned. They are being educated with the best weight loss advice and don’t/can’t follow it. Their life and emotions are excluded from the treatment plan. Their unique struggles aren’t addressed. Obesity is a complex condition that requires a complex approach for meaningful influence.

With a focus on total person health, TrestleTree moves beyond the usual approach to obesity and integrates a multi-behavioral health focus (e.g., nutrition, exercise, co-morbid conditions like diabetes and hypertension, sleep, medication adherence) with stress management and psychosocial and sociocultural factors (e.g., cultural factors, finances, family, occupation). For the past 20+ years, TrestleTree has intentionally applied a unique and robust model to drive influence and outcomes for all individuals, irrespective of their motivation level. This means that we have an effective solution even for those individuals who have given up hope to lose weight, who feel helpless in this effort, and/or who choose not even to look at their weight. In fact, over these two decades, 58% of TrestleTree participants with a BMI ≥ 30 lost an average of 13.4 pounds. These outcomes include all individuals who had a BMI ≥ 30 and joined the TrestleTree health coaching program, even if they didn’t want to work on their weight or were joining for a different reason (e.g., managing hypertension, quitting smoking).

58% of all TrestleTree participants with a BMI ≥ 30 lost an average of 13.4 pounds, irrespective of why they came into the program.

To accomplish this, TrestleTree hires a multidisciplinary staff of healthcare professionals who participate in unparalleled initial and ongoing training by TrestleTree’s Ph.D. Psychologists, such that our Health Coaches have a depth of understanding about the intersection of obesity, health and life. Life is messy. Health is messy. Obesity is messy. TrestleTree Health Coaches value, understand, elicit, and incorporate this messiness into strategic interventions to effectively impact obesity across all individuals. In addition to having tangible influence on obesity, our multi-behavioral model has shown tremendous influence on associated conditions, with book of business results over 20+ years showing that 78% of at-risk participants reduced cholesterol from an average of 272 mg/dl to 210 mg/dl, 74% of at-risk participants lowered blood pressure from an average of 149/92 mmHg to 128/78 mmHg, and 69% of at-risk individuals reduced their HbA1c from 8.8% to 7.2%. TrestleTree has done this with a proven model based on the science and art of behavior change.

Supplementary Interventions for Weight Loss

As noted previously, supplementary interventions may be added to lifestyle interventions as part of a more holistic weight loss program. One example of an adjunct therapy is anti-obesity medications (AOMs), with newer AOMs increasingly showing a very high level of effectiveness in helping people lose weight and manage obesity long-term, in conjunction with an effective wrap-around lifestyle intervention. In November 2022, the American Gastroenterological Association (AGA) published clinical practice guidelines that “strongly recommended adding AOMs to lifestyle intervention in adults with obesity or overweight with weight-related complications, who have had an inadequate response to lifestyle interventions.” In their review of evidence from randomized control trials, the AGA noted that the recommended AOMs “…should be based on factors such as co-morbidities, patient preferences, costs and access to treatment.” Given even newer medications currently being evaluated and fast tracked for approval by the FDA, and many individuals’ hesitance to undergo weight loss surgery, AOMs are gaining more attention for their significant positive impact on weight and health, alongside lifestyle interventions.

Anti-obesity medications, as part of a comprehensive plan that includes lifestyle intervention, can help people manage obesity in the long-term.

As another example of an adjunct intervention for weight loss, with more focus on telehealth, remote monitoring devices (e.g., scales, blood pressure monitors, glucometers) are now more readily available and promoted as part of health improvement programs. While some studies have shown that remote patient monitoring devices can reduce acute care use, there are limited studies across conditions and populations. For some people, self-monitoring tools such as wireless devices can increase awareness and may lead individuals to take ownership and control over their behaviors, thus prompting change.

two weights on a scale on hardwood floor

Remote monitoring devices can provide real-time data, allow for proactive management of conditions, and extend access to care for many patients. Wireless, remote scales can be incorporated into a broader lifestyle intervention on obesity, while wireless blood pressure monitors and glucometers can simultaneously provide valuable data to track and influence co-morbid conditions. However, even when adding supplemental interventions for obesity to lifestyle interventions, approaches that still focus primarily on provision of information and selfdirectedness by less motivated patients will not suffice to drive meaningful and sustainable clinical outcomes. Case in point, in their recommendations on AOMS, the AGA noted that while lifestyle interventions are “an essential aspect of an obesity prevention or treatment program,” there is a lack of standardized definition for these efforts. Also, a 2021 systematic review of remote patient monitoring, published in BMJ Open, highlighted factors that positively influence the effectiveness of remote monitoring, including personalizing care, increasing motivation to use the remote monitoring device, and being part of a more comprehensive approach. When it comes to AOMs, are individual’s hopes and fears being elicited? Do they know how to talk with their doctor about AOMs and what to do if their doctor won’t prescribe one? When it comes to the use of remote patient monitoring devices, are individuals simply being alerted to out-of-range numbers? When they are ‘non-compliant’ in using the device, is there a connected behavior change expert who can roll up her/his sleeves and identify the associated psychosocial and sociocultural factors?

Achieving Total Person Health

TrestleTree’s model to address obesity is one that incorporates two-way, dual voice communication, both with lifestyle interventions and adjunct therapies such as AOMs and remote patient monitoring devices. We must learn from our patients at the same time we influence them, if we want to influence them effectively. Especially for those patients who are less motivated. We must elicit and listen to their unique stories, their unique messiness, their unique struggles and hopes. Effective strategies to combat obesity must move beyond provision of information and include behavior change influence tailored for each individual, even those who are less motivated.

We have an opportunity to connect with people, build trust with them, increase their motivation, and provide them tangible tools to break the vicious cycle of obesity, improve health, lower costs, and change lives. With over 20 years of rich history and experience, TrestleTree is committed and well equipped to partner with employers, health systems and occupational medicine clinics to extend and deepen their reach, presence, and impact, as well as support the transition to total person health (TPH). TrestleTree is excited and motivated to develop partnerships with your organization, build this expertise into the workings of occupational medicine, and extend your value and impact. TrestleTree stands ready to collaborate and transition to total person health for the betterment of health and wellness in your thriving organizations.

Let’s have a discussion on how TrestleTree can partner with you to attack obesity in the workplace!

This article was originally published in Visions, the periodical of The National Association of Occupational Health Professionals (NAOHP).


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