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Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association
Open accessAbstract
Obesity is a recognized public health epidemic with a prevalence that continues to increase dramatically in nearly all populations, impeding progress in reducing incidence rates of cardiovascular disease. Over the past decade, obesity science has evolved to improve knowledge of its multifactorial causes, identifying important biological causes and sociological determinants of obesity. Treatments for obesity have also continued to develop, with more evidence-based programs for lifestyle modification, new pharmacotherapies, and robust data to support bariatric surgery. Despite these advancements, there continues to be a substantial gap between the scientific evidence and the implementation of research into clinical practice for effective obesity management. Addressing barriers to obesity science implementation requires adopting feasible methodologies and targeting multiple levels (eg, clinician, community, system, policy) to facilitate the delivery of obesity-targeted therapies and maximize the effectiveness of guideline-driven care to at-need patient populations. This scientific statement (1) describes strategies shown to be effective or promising for enhancing translation and clinical application of obesity-based research; (2) identifies key gaps in the implementation of obesity science into clinical practice; and (3) provides guidance and resources for health care professionals, health care systems, and other stakeholders to promote broader implementation and uptake of obesity science for improved population-level obesity management. In addition, advances in implementation science that hold promise to bridge the know-do gap in obesity prevention and treatment are discussed. Last, this scientific statement highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.
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“Using both BMI and waist circumference provides complementary prognostic information regarding risk for future metabolic derangements, incident CVD, and mortality.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“There are, however, many published qualitative systematic reviews and meta-analyses on this topic.25–29”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Weight management has myriad benefits in T2D, including reductions of A1C and hepatic steatosis, and improvement in cardiovascular risk factors.26,29”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adverse CKM risk factor levels (overweight/obesity, hypertension, hypertriglyceridemia, diabetes, CKD) during the prepregnancy period are associated with increased risk of APOs.18,29”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“While waist-hip ratio provides improved characterization of metabolic and cardiovascular risk than waist circumference, challenges of complexity of measurement and lack of standardization make it less ideal for use in clinical settings.18,29–32”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
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“Fortunately, GLP-1–based therapy has been shown to mitigate postsurgical weight regain in several observational studies.10–12,29”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
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“Studies examining the cost-effectiveness of adding SGLT2i to prior standard care in patients with diabetes found that, from a US health care sector perspective, this approach is projected to be cost-effective compared with standard therapy.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“A high-quality modeling study examining the cost-effectiveness of dapagliflozin in nondiabetic CKD found that dapagliflozin improved life expectancy by 2 years, increased discounted QALY (from 6.75 to 8.06), and reduced incident kidney failure requiring kidney replacement therapy over the lifetime of the cohort.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“While these trials did not recruit patients with pre-HF or analyze this subgroup, post-hoc biomarker substudies of these trials suggested a high median NT-proBNP and hs-cTn, with >50% of the trial population demonstrating biomarker levels consistent with pre-HF.27–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“The UK HARP 3 (UK Heart and Renal Protection III) trial in patients with CKD demonstrated no significant difference between the kidney effects of ARNI and ARB, although only a small proportion of participants had HF.29”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“Data from meta-analyses and pooled studies demonstrate that individuals at highest risk for MASLD and its progression include those with T2D and/or those with more than 2 cardiometabolic risk factors such as obesity, hyperlipidemia, or hypertension.14,28–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Using data from the National Health and Nutrition Examination Survey (NHANES) III, MASLD prevalence and severity increased with a higher number of metabolic comorbidities, particularly in persons with T2D, and those with MASLD and T2D had the highest risk of mortality.29,30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [29]
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Citations
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“40,42,43 Although structural factors that unfairly limit access to surgery account for some of the inequities, additional reasons include the perception and reality that the social supports needed for surgery to be successful are absent in underresourced populations with the greatest needs.”
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“However, maintaining long-term use for patients may be challenging due to factors such as gastrointestinal adverse effects, treatment burden, medication cost, and patient expectations regarding treatment outcomes [13, 15, 16, 22, 23 ].”
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“United States, 1% of eligible individuals receive lifestyle modification for obesity [1], with similar trends for the implementation of obesity medications and metabolic and bariatric surgery (MBS) [2, 3].”
Evolving indications for metabolic and bariatric surgery
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Behavior change support in the new era of obesity care
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“…gap reflects limited clinician training, weak referral pathways to allied healthcare professionals providing counseling, coaching and ongoing support, inadequate reimbursement, and care models that fail to address the psychological, social, and structural barriers to behavior change [2].”
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Digital health, technology, AI, and wearables in obesity care
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“This interpretation is consistent with contemporary obesity frameworks that emphasize heterogeneity, complication-oriented care, and the need to translate obesity science into individualized clinical practice rather than relying on uniform management strategies [3,6].”
Kassem, S. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71293 · Cited by 2
“Racial and socioeconomic disparities further exacerbate this issue, with Black and Hispanic/Latino adolescents and adults, as well as individuals with limited social and economic resources, significantly less likely to undergo surgery [24].”
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Practical use of GLP-1-based medications in obesity clinics
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Pasarica, M., Kushner, R. F., Leary, A. V., Grunvald, E. L., Velasquez, S. A. T., Uhley, V. E., Johnson, M. S., Ricardo, C., Carpenter, D.-A. L., Velazquez, A., et al. (2026) · International Medical Education · doi:10.3390/ime5040110
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“23 Patients with higher BMI underwent more extensive ablation strategies, with fewer PVI-only procedures and more frequent additional lesion sets.”
Metadata
- Authors
- Laddu, D., Neeland, I. J., Carnethon, M., Stanford, F. C., Mongraw-Chaffin, M., Barone Gibbs, B., Ndumele, C. E., Longenecker, C. T., Chung, M. L., Rao, G., & on behalf of the American Heart Association Obesity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Clinical Cardiology; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; and Council on Cardiovascular and Stroke Nursing
- ORCID
- Venue
- Circulation
- Published
- 2024-07-02
- Volume
- 150
- Issue
- 1
- Pages
- e7-e19
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC11416804
- OpenAlex
- W4398144590
- Semantic Scholar
- 621886cfd30e421d9937d5cc151dd8bbce9cc20d
- Cited by
- 62
- References
- 79
- Citations by year
- 2026: 37 · 2025: 18 · 2024: 7
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Heart Association
- Office of Science
- National Heart, Lung, and Blood Institute (K01HL148503)
- National Institute of Nursing Research (R01NR019456)
- National Institute of Diabetes and Digestive and Kidney Diseases (U24DK132733, UE5DK137285)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity and Health Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity, implementation science, clinical translation, obesity treatment, lifestyle modification, obesity pharmacotherapy, bariatric surgery, cardiovascular disease, health policy, health equity, implementation barriers, obesity prevention
- MeSH terms
- American Heart Association, Humans, Obesity, United States
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