2022 Atlanta Board of Trustees Meeting

progression to unhealthy weight, to relapses in weight loss (including post-surgery relapse), and to progression to type 2 diabetes and other co-morbid conditions. More AOM therapies are expected to emerge in coming years; up to 250 anti-obesity medications are now in development. 14 New models of comprehensive team-based care, and services delivered by telehealth and over virtual care platforms have produced positive outcomes in controlled experiments, including services that incorporate the evidence-based Diabetes Prevention Program. 15–17 Digital chronic disease management platforms can also act as a source of evaluation and referrals for weight loss surgery and prescription of anti-obesity medications. Clinical practice guidelines from the nation’s physician specialty societies increasingly support earlier and more intensive interventions to control obesity among patients with identifiable health risks. Nevertheless, by most estimates, uptake of active obesity treatment remains below levels that would otherwise by clinically indicated. 18–22 Factors in poor uptake of obesity treatment may include:  the effect of stigma in dampening patient and provider willingness to engage in treatment  unfamiliarity with current treatment options among providers, patients, and payers  limitations on patient eligibility and access to treatment options (such as AOMs and weight loss surgery) due to variation in policy among health plans  gaps in the capability to measure the effectiveness and durability of treatment (including patient adherence and persistence) that limit the development of health care quality measures for use by payers in insurance plan design and provider payment models, and  limitations in provider payment support for more proactive outreach by providers to patients and for design of comprehensive obesity treatment delivered at greater scale. 18,23,24 Evidence: What is the strength of evidence supporting obesity treatment care models and treatment options? What are the outstanding gaps in evidence? Is better evidence forthcoming? Integration of care: Can the new care models, online services, and medication options be well integrated into a coherent plan of care? How can in-person and virtual services be integrated effectively into comprehensive care for the patient? Is integration of services cost effective? Risk stratification and patient targeting : If payers must set priorities for targeting intensive services to patients with greater risks, how should these priorities be set? How effectively can payers identify patients by their levels of health risk or health service needs? What should be the criteria for stratifying patients in need? Benefit design: In what ways must insurance benefits be designed to complement uptake and adherence to obesity treatment options, such as virtual weight management and appropriate use of anti-obesity medications? How would payers determine cost offsets and avoidance due to obesity treatment? Several reasons for payer reluctance to intensify payment support for obesity treatment can be hypothesized. 24,25 26–28 They include:

Adherence and persistence : Can meaningful results in obesity treatment be sustained over time? What are the feasible approaches to maintaining and measuring adherence to and

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