Obesity management is a complex and multi-dimensional challenge, requiring healthcare professionals to focus on the individual in front of them, moving beyond traditional paradigms of “eat less, move more.” Drawing from the expertise of Dr. Renee Rogers, this blog outlines critical elements of obesity care—emphasizing muscle health, personalized strategies, and the integration of modern treatment pathways such as pharmacotherapy and surgery.

Reframing the Approach: From Weight to Health and Well-being

Managing obesity involves shifting the focus from body weight alone to a broader understanding of body composition and overall health. This includes:

• Body Composition: Assessing both the quantity and quality of tissue changes, with attention to muscle mass and function. Tools like bioelectrical impedance analysis (BIA) provide practical insights, while advanced methods like DEXA offer more detail, albeit with limited accessibility. While DEXA is often considered the gold standard for certain measurements, practical tools like validated BIA can be more suitable in clinical settings.
• Muscle Health: Highlighting muscle quality and metabolic health as essential targets, particularly in the context of contemporary pharmacotherapies and surgical interventions. Resistance training, even in a hypocaloric state, can play a key role in preserving muscle health and improving functionality, though more research is needed to fully understand its long-term impact on muscle volume and function.
• Patient Well-being: Prioritizing health outcomes that align with the patient’s goals and quality of life. For some patients, particularly those with obesity, gaining muscle instead of focusing solely on weight loss can be an excellent outcome if it aligns with their goals and improves overall health and functionality.

Person-Centered Care: Meeting Patients Where They Are

A successful treatment strategy acknowledges the unique needs and barriers faced by patients. Dr. Rogers emphasizes the importance of avoiding method-centric recommendations and instead tailoring care to the individual. This means:

• Engaging in Meaningful Conversations: Asking questions like, “What activities have you enjoyed in the past?” and “What concerns or fears do you have about starting an exercise program?” can help patients feel understood and supported.
• Setting Realistic Goals: Small, attainable objectives—like improving energy or mobility—can build confidence and foster long-term engagement.
• Framing Activity as a Tool: Instead of prescriptive advice like “just go to the gym,” discuss how movement can enhance energy, function, and quality of life. For example, combining resistance training with performance-based exercises such as balance or mobility can help patients track progress and stay motivated.

Integrating Contemporary Treatment Pathways

Effective obesity management is not an either/or decision between lifestyle, pharmacotherapy, and surgery. Rather, it’s about leveraging all available tools in a complementary way.

Key principles include:

• Lifestyle Interventions: Foundational to all medical management strategies, emphasizing sustainable changes that align with patients’ life stages and abilities.
• Pharmacotherapy and Surgical Support: Contemporary pharmacotherapies enable significant weight loss (15-20%) while also improving related conditions like type 2 diabetes and cardiometabolic risk. Similarly, bariatric surgery requires careful consideration of muscle and bone health, especially for populations like menopausal patients.
• Shared Decision-Making: Involving patients in navigating treatment options ensures alignment with their goals and values.

Practical Strategies for Healthcare Professionals

1. Measure What Matters: Focus on body composition rather than weight alone. Use tools like BIA to gain insights into fat-free mass, skeletal muscle, and other metrics. For example, tracking skeletal muscle index or fat-free mass can help identify risks such as sarcopenia or malnutrition. While universal cutoffs may not yet exist for all populations, comparative rankings based on age, gender, and ethnicity offer valuable context.
2. Tailor Nutrition Plans: Adequate protein intake is critical for preserving muscle mass, particularly in hypocaloric states. While protein may not always be strictly controlled in studies, it plays a vital role in supporting muscle health during weight loss or maintenance efforts.
3. Balance Caloric Needs: Contrary to popular belief, excessive calorie consumption isn’t necessary to build muscle. A slight caloric surplus paired with adequate protein and nutrient timing can promote muscle growth without significant fat gain.
4. Address Barriers: Understanding obstacles such as discomfort, stigma, or logistical challenges is critical. Engaging patients in meaningful conversations and celebrating gradual progress can help sustain motivation.

Q&A: Insights from the Webinar

Q: Is it necessary to eat excess calories to maximize muscle gains, even if fat gain occurs?

A: No, it’s not necessary to consume excessive calories to maximize muscle gains, especially for individuals trying to lose fat. Consuming adequate protein and ensuring nutrient timing, along with a slight caloric surplus, can support muscle growth without significant fat gain. It’s about striking a balance and tailoring strategies to individual goals.

Q: Are there data to support resistance training over aerobic training for obesity management?

A: Aerobic training is most effective for weight loss due to its role in energy expenditure. However, resistance training is crucial for preserving lean mass, particularly during weight loss efforts. The best approach depends on the individual’s preferences and goals, with consistency and enjoyment being key factors.

Q: How do you approach body composition measurement and tool selection?

A: Measuring body composition is critical for guiding treatment strategies. Tools like BIA offer practical insights, while methods like DEXA provide more detailed data but are less accessible. The key is understanding the limitations of each tool and preparing patients to ensure accurate results.

Q: Is gaining muscle without losing weight a good outcome for patients with obesity?

A: Absolutely. Focusing on muscle health rather than weight loss can be a positive outcome if it aligns with the patient’s goals. Improving muscle strength, functionality, and overall quality of life often matters more than the number on the scale.

Better Conversations, Better Outcomes

Dr. Rogers’ research highlights the importance of patient-provider dialogue in overcoming common obstacles. Key conversation starters include:

• “What activities have you enjoyed in the past?”
• “How are your energy levels, and how might movement help you feel and function better?”
• “What are your goals beyond weight loss?”

These discussions pave the way for personalized care strategies that emphasize muscle health, functional improvements, and overall well-being.

Moving Forward: The Role of the Interdisciplinary Team

Comprehensive obesity care requires collaboration among dietitians, exercise physiologists, behavioral health specialists, and other professionals. Key steps include:

• Referring to Resources: Direct patients to community programs or tools that align with their preferences and abilities.
• Promoting Obesity-Sensitive Communication: Reduce stigma and create a supportive care environment.
• Emphasizing Nutritional Adequacy: Particularly for patients on pharmacotherapies who may experience reduced appetite.

By integrating person-centered strategies with contemporary medical treatments, healthcare providers can empower patients to achieve sustainable health improvements. Focusing on muscle health, meaningful engagement, and interdisciplinary collaboration allows for a more inclusive and effective approach to obesity management. Ultimately, the goal is to build trust, address barriers, and keep the patient’s well-being at the forefront of care.