Obesity care goes beyond mere body weight reduction in a number of ways, all of which tie back to an unwavering focus on improving patients’ health:

Comprehensive, individualized treatment

Obesity is a complex, multifactorial, relapsing chronic disease that requires a highly individualized treatment approach. Before starting a patient on an anti-obesity medication, we must develop a comprehensive, personalized education and treatment plan that takes into account all the specific factors contributing to that individual’s weight gain and those preventing weight loss (from physical activity and nutrition, to sleep patterns and stress, to previous weight loss experience, to other health conditions and medications). Treatment may include GLP-1 medications, but there’s no one-size-fits-all solution.

Careful prescribing

We call the medications anti-obesity medications rather than weight-loss drugs for a reason: they’re designed for long-term treatment of the chronic disease of obesity. We can’t just prescribe Wegovy or Zepbound and send patients on their way. These medications are generally well tolerated when prescribed appropriately, but not all patients with obesity are good candidates. We need to support those who are with dietary strategies and personalized titration schedules to minimize side effects, as well as education to identify early warning signs way before more serious adverse events occur.

Addressing comorbidities

Obesity leads to dysregulation in a variety of physiological pathways that can affect virtually every body system. Obesity is associated with more than 200 health conditions, including heart disease, hypertension, type 2 diabetes, osteoarthritis, sleep apnea and certain types of cancer, to name just a few. Treating obesity includes addressing these comorbidities. While it’s true that weight loss itself can lead to improvements in many of these weight-related health conditions, it’s not always a straightforward process. Individuals with obesity often have multiple comorbidities, and many are already taking multiple medications — creating additional variables and potential interactions to manage.

Health-related goals

Patients with obesity may present with specific weight goals they’d like to achieve, but as providers, we emphasize instead the importance of health outcomes, such as measurable improvements in metabolic health markers. The healthy lifestyle habits incorporated into the treatment plan underscore this focus, and a patient’s ability to decrease or discontinue other medications — for hypertension or diabetes, for example — often depends not only on the amount of weight lost, but also on these complementary lifestyle changes.

Support for long-term weight maintenance

Patients need to be aware that the initial weight loss period is only the first stage in a lifelong journey. Obesity is a chronic disease — one that we don’t yet have a cure for — which means that weight management requires long-term commitment. As clinicians, our job isn’t finished when our patients bring their weight down; we need to provide ongoing support to help them sustain the healthy behavior changes they’ve made, avoid medication discontinuation, and make adjustments and get back on track when they encounter the inevitable challenges along the way. Weight maintenance is often more difficult than weight loss, and patients frequently underestimate how much ongoing support they’ll need.

We’re thrilled to have so many new anti-obesity medications in our armamentarium — medications that are extraordinarily effective at helping individuals lose weight. But weight reduction is just part of the obesity treatment story. As clinicians, we need to make sure we’re looking beyond the number on the scale and delivering holistic, empathetic, evidence-based care tooptimize our patients’ overall health and well-being.

** I’m honored to be a member of the International Obesity Collaborative (IOC), a global initiative to address obesity internationally. Comprised of 12 leading obesity organizations, the IOC aims to raise awareness, share best practices, and implement effective interventions to treat obesity around the world.  We recently published the consensus statement: “Obesity Care vs. Weight Loss.” Stay tuned for more publications by the IOC.

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Professional guidelines already advise against using common medications such as steroids or NSAIDs such as Ibuprofen as a first line treatment for acute or chronic back pain.

Now a new study has been published which associates early use of these medicines with development of chronic back pain.

Lower back pain is a leading driver of disability across the globe, so the idea that what people commonly reach for to get some relief may be leading to worse outcomes and increased misery for millions of people should be taken seriously.

Hopefully more studies will be done, including clinical trials, which can provide evidence for causation.

In the meantime, it is already the position of numerous professional organizations, including the American Academy of Family Physicians, that non-drug treatment options such as superficial heat, massage, spinal manipulation, and other non-drug treatments should be tried before medications.

Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or subacute low back pain.

Which begs the question, if a bunch of different treatments are all shown to be equally effective for the treatment of a common condition, which treatment do you choose?Chiropractic Care Versus Medication For Chronic Lower Back Pain In Elderly PatientsThe evidence increasingly favors spinal manipulation over prescription drugs when considering patient satisfaction and…medium.com

I’d propose you pick the treatments which are both cost effective and offer the least adverse side effects. While over the counter NSAIDs are certainly cost effective, this study provides some evidence that they may not be as benign in terms of side effects as many people assume.

The tendency to use nonsteroidal anti-inflammatories persists despite their unimpressive performance. An analysis of randomized clinical trials found that these drugs had almost no benefit over placeboes in reducing low back pain.

Chiropractic care often involves several modalities recommended as first line treatments in the care of acute and subacute back pain. Typically a visit to the chiropractor will involve some superficial heat, patient education, reassurance, soft tissue treatment such as massage, spinal manipulation (chiropractic adjustment), stretching, lifestyle modification advice, or home exercise recommendations.When Your Back Hurts, Sometimes It’s Better Not Knowing Exactly WhyYou want an answer, but there are hidden costs to finding out.medium.com

While usually not as inexpensive as a $7 bottle of Advil, chiropractic care is often given some of the highest marks for patient satisfaction and appears comparable in cost effectiveness to standard medical care.

It Can Be Overwhelming

There are so many options when trying to decide what to do about a case of acute back pain. It can feel like you’re in a supermarket with too many options. Not everyone is going to respond the same way to a treatment, further confusing things. Some people love a visit to the chiropractor, other people hate getting adjusted. My wife doesn’t like acupuncture, I find it helps.

What I recommend to my patients is what I understand to be effective, low-risk, and evidence based. It is not in my scope of practice to tell a patient what medications to take or not to take, but as an aspect of informed consent I do tell my patients what other options they have for their care.

If they are in my office I am going to be biased and recommend a trial of chiropractic care for most cases of acute back pain, but they have other options such as yoga, acupuncture, exercise, topical analgesics, medications, et cetera.

Does this recent study pointing out there may be more risk involved in taking common medications confirm my bias towards conservative non-pharmacological interventions for pain? Yes. Does it mean I will stop taking Ibuprofen when I have pain? Probably not, but I might think twice the next time I reach for when my shoulder or back feels cranky.

Works Consulted:

DOI: 10.1126/scitranslmed.abj9954Common Medications Can Prolong Back Pain, Study SaysA clinical trial will be needed to verify the research, which offered a warning about taking steroids or…www.nytimes.com

doi.org/10.7326/M16–2367

Haas, Mitchell et al. “Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.” Journal of manipulative and physiological therapeutics vol. 28,8 (2005): 555–63. doi:10.1016/j.jmpt.2005.08.006

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