Gaps to bridge: Misalignment between perception, reality and actions in obesity

Abstract

Aims Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). Materials and methods An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care. Results A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow‐up appointments are required. Conclusions Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.

Desire to lose weight and need of weight loss support in the adult population—Results from a cross‐sectional study in Sweden

“…One of the advantages of the present study is that it is based on a considerable sample of the general population in a large geographical area and represents a wide age group of men and women from 30 to 69 years. Comparable findings on, for example, high motivation to lose weight among persons with obesity have also been found in other studies, 23,34 but these studies have been limited to health care patients. Although the study included only five counties, it covers the general adult population in these counties, comprising over one million inhabitants.…”

“…This is particularly important because of the high prevalence of previous weight loss attempts among persons with obesity, the lack of standardized weight control methods offered by the health care system, and the discouraging long-term results of weight loss attempts. 23,24,28 In the current study, it was not specified whether the support required for weight loss meant support from the health care provider or, for example, from family, friends or others, but because of the high prevalence of various types of health problems, it seems reasonable that the support should be provided by the health care system. Multiple barriers to weight loss, such as high BMI, more health conditions, and low confidence among patients with obesity, have also been reported from a study conducted in primary care in the United Kingdom.…”

“…According to a recent international study by Caterson et al, 81% of people with obesity assume full responsibility for weight loss, but a majority would like a health care professional to initiate a conversation about weight management. 23 Internationally, the main determinants of weight control attempts are high BMI and gender. 14,[20][21][22]24,25 Women try to lose weight to a greater extent than men, 14,[20][21][22]24,25 although overweight and obesity are not more common among women.…”

Should obesity be recognised as a disease?

“…Healthcare professionals seem ill informed on the complexity of obesity and what patients with obesity want. In a study of attitudes to obesity in 11 countries, 71% of 2800 healthcare professionals thought that patients did not want to discuss their obesity, whereas only 7% of 14 500 people with obesity agreed 10…”

“…The stigmatisation of obesity leaves patients fearful of discussing their weight, and they turn to fad diets or non-prescription medication because they assume that their obesity is solely their responsibility. Unfortunately, patients delay discussing their obesity with their general practitioner by an average of six years10; this is perhaps because of the common misconception that “eat less and move more” will cure obesity and that this will be their prescription.…”