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The Role for Hospitalists During the Obesity Epidemic

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Obesity places individuals at risk for multiple health problems, including cardiovascular disease, type II diabetes mellitus, sleep apnea and some cancers. According to the Centers for Disease Control and Prevention (CDC), over a third of adults in the U.S. are obese, and annual direct medical costs for obesity are in the billions of dollars. Further, research has shown that rates of obesity continue to rise in the U.S.

The National Heart, Lung, and Blood Institute (NHLBI) supports research, education and training to help heighten awareness, knowledge and prevention of obesity and its complications. One recent perspective article specifically supported by the NHLBI looked at implementation of obesity guidelines during hospitalizations, and the role hospitalists may have in this process. Obesity guidelines were updated in 2013 by the American Heart Association/American College of Cardiology (AHA/ACC) Task Force on Practice Guidelines and The Obesity Society (TOS) to help curb the rise of obesity and empower healthcare providers with strategies to intervene. Because the obesity epidemic affects a significant portion of those in the U.S., hospitalists should anticipate caring for an increasing number of this patient population. Hospitalizations may potentially serve as unique opportunities and times for hospitalists to initiate or continue to build upon obesity guidelines for patients with obesity, who are open to counsel.

It has already been determined that many hospitalized patients with obesity welcome weight loss interventions during their hospitalization even if they are hospitalized for non-obesity related medical illnesses. As such, initiation of hospitalists’ intervention may be an ideal approach to launch or continue discussion and education about weight loss and set up outpatient linkage to care for obesity management for those that qualify. This in turn, may possibly lead to improvement in patient outcomes post discharge, such as reduction in hospital costs and re-hospitalizations for obesity related complications. Furthermore, inpatient weight loss interventions may be the catalyst necessary to help hospitalists and their hospitals meet the nation’s obesity guideline goals.

It is important to note that not all patients routinely have outpatient primary care providers, and sometimes even when they do, weight loss may not routinely be addressed. Thus, hospitalizations may be one of the only times that some patients with obesity encounter healthcare providers. Hospitalists should make specific efforts to diagnose, manage and provide discharge plans for obesity as they would any other chronic medical disease encountered during routine hospitalizations.

There is currently no clear evidence that the epidemic will plateau or decline any time soon. Hence, obesity should be considered a public health emergency because of its association with higher morbidity, mortality and healthcare costs compared to those who are not obese. Hospitalists may hold the key that is critical to crippling the obesity epidemic.

Dr. Ché Matthew Harris is a hospitalist and assistant professor of medicine at the Johns Hopkins Bayview Medical Center. His research interests focus on weight loss interventions for hospitalized adults with obesity. He is a member of the American Medical Association and is a fellow of the American College of Physicians.

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