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. 2019 Jun;9(3):e12309.
doi: 10.1111/cob.12309. Epub 2019 Apr 11.

A call to action to inform patient-centred approaches to obesity management: Development of a disease-illness model

John Fastenau  1 , Ronette L Kolotkin  2   3   4   5   6 , Ken Fujioka  7 , Maria Alba  1 , William Canovatchel  1 , Shana Traina  1
Affiliations

A call to action to inform patient-centred approaches to obesity management: Development of a disease-illness model

John Fastenau et al. Clin Obes. 2019 Jun.

Abstract

Patient-centred care is an essential component of high-quality health care, shown to improve clinical outcomes and patient satisfaction, and reduce costs. While there are several authoritative models of obesity pathophysiology and treatment algorithms, a truly patient-centred model is lacking. We describe the development of a patient-centric obesity model. A disease-illness framework was selected because it emphasizes each patient's unique experience while capturing biomedical aspects of the disease. Model input was obtained from an accumulation of research including contributions from experts in obesity and patient-reported outcomes, qualitative research with adults living in the United States, and two targeted literature searches. The model places the patient with obesity at its core and links pathologic imbalances of energy intake and expenditure to environmental, sociodemographic, psychological, behavioural, physiological and medical health determinants. It highlights relationships between obesity signs and symptoms, comorbid conditions, impacts on health-related quality of life, and some barriers to obesity management that must be considered to attain better outcomes. Providers need to evaluate patients holistically, understand what changes each patient is motivated to make, and recognize what challenges might impede weight reduction, improvements in comorbid conditions, signs and symptoms, and health-related quality of life before pursuing individualized treatment goals. Patients living with obesity who do lose weight perceive benefits beyond weight loss. Ideally, this model will increase awareness of the complex, heterogeneous impacts of obesity on patients' well-being and recognition of obesity as a chronic disease, and prompt a call to action among stakeholders to improve quality of care.

Keywords: modelling; obesity; quality of care.

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Conflict of interest statement

J.F., M.A., W.C. and S.T. are full‐time employees of Janssen Research & Development, LLC. R.L.K. has served as a consultant to Novo Nordisk, Eisai and Janssen; has served on an advisory board and steering committee for Novo Nordisk; and receives royalties from Duke University for the IWQOL‐Lite. K.F. has provided consulting services to Orexigen, Novo Nordisk, Eisai, Zafgen, Janssen Global Services, Gelesis, Ambra, KVK‐Tech, Boehringer Ingelheim and Shire.

Figures

Figure 1
Figure 1
The obesity disease‐illness model. HRQoL, health‐related quality of life
See this image and copyright information in PMC

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