Individuals or groups that can bridge clinical and community systems are known as integrators. Despite the significant role of the environment in the development of the obesity epidemic, medical systems have not generally engaged with community organizations to improve access to and consumption of healthful foods or to improve the conditions that foster physical activity. The integration of clinical and community systems presents a challenge. However, patients’ successful and sustained weight loss is unlikely to occur without supportive changes in the social and community systems that contributed to the development of obesity in the first place. Changes in the design of the clinical delivery systems are required to develop a standard of care that responds with sensitivity to the bias and stigma that accompany obesity and the recognition by clinicians of the social and environmental context in which their patients’ obesity occurs. Engagement and activation can be prompted by individuals, their families, social networks, or providers. Because integration requires partnerships and collaboration, measures should also determine the success of these interactions.Įngagement of patients and their active participation in clinical care and community systems are central to the success of this model. Success will be measured by metrics that are acceptable and agreed on by all the parties included in the model. Successful implementation of the model addresses health equity at every level of the framework.
Health equity, also included in the outer ring, is a priority that influences all health outcomes, especially because obesity disproportionately affects ethnic minorities. Training and education are included in the outer ring because the knowledge and skill set of health care and community-based professionals determine the effectiveness of the integrated system. The interlocking systems influence and are influenced by the broader context of population health, where national, state, and local policies shape supportive environments and choices. The tight linkages result from integrated clinical and community systems that serve to engage and empower patients and their families to optimize health outcomes. The figure illustrates the tight linkages among family and individual engagement and empowerment, care delivery, and community systems. We propose here a framework that integrates clinical and community systems to prevent and manage obesity ( Figure 1) (Dietz et al., 2015). Neither clinical nor environmental changes alone are sufficient to address a problem of this magnitude.
Obesity now affects 35 percent of men, 40 percent of women, and 17 percent of 2- to 19-year-old children and adolescents in the United States (Flegal et al., 2016 Ogden et al., 2016).