A Framework for Physician Assistant Intervention for Overweight and Obesity
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JAAPA_PAsConnectThis article appears in the July issue of the Journal of the American Academy of Physician Assistants.

The American Academy of Physician Assistants (AAPA) convened a six-member expert panel, including five practicing PAs (with nearly a century of combined experience), to develop a framework that can be used by physician assistants (PAs) and other medical providers to effectively combat overweight and obesity. The expert panel members represent a broad array of medical and surgical specialties that often treat conditions related to overweight and obesity: family practice, internal medicine, endocrinology, interventional and general cardiology, sports medicine, occupational medicine, emergency medicine, hospitalist medicine, and general, orthopedic, and cardiothoracic surgery. This broad experience is critical background to support an effective action plan. In addition to bringing its own expertise and experience to the matter, the panel reviewed the work of other expert groups on this topic, focusing on recent position papers from the American Association of Clinical Endocrinologists and the American College of Endocrinology.1,2 The panel also reviewed a selected bibliography of more than 30 articles reflecting the current knowledge of overweight and obesity.

The panel concluded that the pathogenesis of overweight and obesity conforms to the chronic disease model. Overweight and obesity as diseases arise from a complex interaction of genetics, environment, and individual and population behaviors that influence disease severity and affect patient health and the development of complications. Even in patients with healthful behaviors, the highly obesogenic environment in the United States places most patients at some level of risk. Therefore, we advocate for a strategy to attack these societal issues in meaningful ways, while clinicians concurrently adopt a chronic care model for the treatment of overweight and obesity. Validating the behaviors of patients with healthful weights also is important.

This article addresses the current lack of diagnostic management clarity surrounding overweight and obesity, which serves as an impediment to clear, concerted and comprehensive action. We propose a new framework for a more meaningful diagnosis of overweight and obesity as a chronic disease that translates emerging concepts into actionable recommendations. Finally, we endorse for PAs a diagnostic algorithm that is mapped to evidence-based, risk-stratified patient subsets and complications-centric management.

The framework has been built on the following key findings:

* All patients should be screened for overweight and obesity using BMI and other measures that more directly quantify adipose tissue mass, including adjustments for ethnic differences in risk thresholds individualized for patients.

* The use of population health techniques, such as registries and electronic health record flags, will help identify patients who are at risk and will enhance their management.

* Screening, diagnosis and staging are important to the development and implementation of disease management options. The goal of weight loss therapy should be to minimize or reduce complications, rather than lower BMI.

Read the rest of the article in JAAPA’s July issue.

Lawrence Herman, MPA, PA-C, DFAAPA; John G. McGinnity, MS, PA-C, DFAAPA; Michael Doll, MPAS, PA-C, DFAAPA; Eric D. Peterson, EdM, FACEHP, CHCP; Amanda Russell, MS, PA-C; Joseph Largay, PA-C, CDE; American Academy of Physician Assistants Overweight and Obesity Task Force.

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