Integrating Community, Clinical Services to Prevent and Treat Obesity

Researchers are proposing a new model to integrate clinical and community services for the purpose of preventing and controlling obesity, as well as related chronic diseases, such as type 2 diabetes.

The outline of the new framework for preventing and treating obesity was published in Health Affairs.

Major challenges of caring for patients with obesity are that obesity varies throughout life and because it affects every organ system, the condition touches every medical specialty. The new Chronic Care Model—the third iteration—reflects the needed integrated system. It centers on patient and family engagement and empowerment and restructures clinical services by providers who will be sensitive to the stigmatization facing patients with obesity.

The model integrates a mix of healthcare providers and practitioners, including professionals not typically considered health professionals, such as community health workers and community leaders, who can play an important role in combatting obesity and related chronic diseases.

“The delivery of care for obesity requires the integration of providers of that care and the integration of health care delivery systems and community services,” the authors wrote.

The new version of the Chronic Care Model integrates existing chronic care and population health models, noting the shared roles of care delivery and community systems. For example, patients cannot choose healthy foods if their community does not provide easy access to healthful food choices. The researchers point out that clinical efforts need complementary community systems that make choosing healthy options easy.

“Although the challenges for implementing the model are substantial, the innovative programs and initiatives cited here, along with new mechanisms and policies supporting these approaches suggest that successful implementation can be achieved,” the authors concluded. “It is abundantly clear that the current disease care system provides a poor return on investment and cannot be sustained.”