Esther Landhuis
March 04, 2025
SAN DIEGO — Obesity not only raises a person’s risk for asthma but also worsens symptoms and responses to standard controller medications. Yet most physicians fail to address weight management when caring for asthma patients with obesity, according to research presented on March 2 at the American Academy of Allergy, Asthma, & Immunology (AAAAI)/World Allergy Organization 2025 Annual Meeting in San Diego.
More than 40% of adults and nearly 20% of children in the United States are obese. GINA guidelines suggest including weight reduction in the asthma treatment plan for people with obesity, noting that even 5%-10% weight loss can improve asthma control. Furthermore, recent US Food and Drug Administration approvals have raised public interest and conversation around weight loss drugs.
To assess how well these practice guidelines are implemented in the clinic, researchers at Brigham & Women’s Hospital in Boston searched electronic health records for adult patients with asthma and obesity. Using an artificial intelligence-based large language model (Open AI’s GPT-4o), the team analyzed free text notes from primary care, allergy/immunology and pulmonary providers who saw these patients between January 2020 and September 2023.
The researchers’ Chat GPT prompts were simple: Is asthma being discussed in the encounter, yes or no? If yes, is obesity management being discussed? If yes, list the strategies for us. If yes, was it discussed in the context of asthma?
In outpatient notes from 17,660 asthma-related patient encounters, only 25.8% included obesity management, the analysis found. And within that subset, less than half discussed weight loss in the context of asthma.
All told, just 12.6% (2219 of 17,660) patients with obesity who received asthma care had a conversation with their medical provider about losing weight to improve their asthma, said Oluwatobi Olayiwola, MD, an allergy/immunology fellow at Brigham & Women’s Hospital and lead author of the unpublished analysis presented at the AAAAI featured poster session. About a quarter of analyzed patient visits occurred by video or phone, but weight management discussions were slightly more common during in-person visits. But “there was not a significant difference,” Olayiwola said.
Among the three practitioner types, pulmonary visits were most likely to include discussion of obesity management as part of the patient’s asthma care. Allergy/immunology providers lagged behind, Olayiwola told Medscape Medical News. “When we do it, though, we are linking it to asthma. It’s just we’re not doing it as much.”
Meeting attendees who visited her poster noted that “just because things aren’t written down doesn’t mean they’re not being discussed,” said Olayiwola. “You know, we’re all busy. We don’t always type every single word. So that’s a limitation of the study.”
Others resonated with the findings. “This is important data,” said Ama Alexis, MD, clinical assistant professor of pediatrics at Weill Cornell Medical College and allergist/immunologist at Hudson Allergy in New York. “Obesity management can be a sensitive issue for patients. Normalizing discussing obesity management as part of a comprehensive asthma plan would be optimal. With more patients taking GLP-1s [glucagon-like peptide 1] and losing a lot of weight, it will be interesting to see how it affects asthma.”
Moving forward, Olayiwola and colleagues hope to pursue interventional studies to see if discussing obesity management actually improves patient outcomes. For example, do patients actually follow-up and go to the referrals? Do they lose weight? Do they come off biologics? Do they use inhaled corticosteroids less frequently?
Olayiwola and Alexis reported no relevant financial relationships.
Esther Landhuis is a freelance science & health journalist in the San Francisco Bay Area. She can be found on X @elandhuis.
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