Survey exposes perception gaps between patients, providers for managing obesity

A recent survey revealed that only half of obese people view themselves as obese, while 28 percent of health care providers (HCPs) don’t believe it is their job to contribute to patients’ weight-loss efforts.

The results, published online Oct. 31 in Obesity, highlighted potential reasons for the difficulties in treating the obese population, which has ballooned to nearly 40 percent of U.S. adults. Researchers surveyed a total of 3,008 adults with obesity, 606 HCPs and 153 employer representatives.

Among the other noteworthy findings:

• 65 percent of people with obesity (PwO) recognized obesity as a disease, but only 54 percent worried their weight may affect future health.
• Only 17 percent of PwO viewed employer-sponsored wellness initiatives as helpful in supporting weight loss.
• 18 percent of employer representatives feel responsible for contributing to weight-loss efforts.
• Among PwO, 71 percent had discussed their weight with a healthcare provider within the last five years, 55 percent reported having been diagnosed with obesity and 24 percent had scheduled a follow-up appointment related to weight.
• 82 percent of PwO felt “completely” responsible for their own weight loss, which the study authors identified as a reason they may not seek help from doctors.
• Two-thirds of HCPs felt “very comfortable” or “extremely comfortable” initiating discussions about weight loss with patients, while one-third reported being “somewhat comfortable” or “a little comfortable” doing so. Similarly, 67 percent of HCPs said they typically initiated weight-loss management discussions, while the other 33 percent waited for patients to broach the topic.
• Commonly cited reasons for HCPs not initiating discussions included lack of time (52 percent), more important concerns/issues to discuss (45 percent) and the belief that the patient wasn’t motivated or interested in losing weight (27 percent and 26 percent, respectively).

“Despite general consensus that obesity is a disease, the strong belief held by PwO that weight loss is their responsibility combined with their relatively low concern about the impact of weight on future health may contribute to their not seeking medical care for it,” wrote Lee Kaplan, MD, a gastroenterologist at Massachusetts General Hospital and the lead author of the study, and colleagues.

“Lack of formal obesity diagnoses, low prioritization of weight loss discussions by HCPs, lack of follow-up care, divergent beliefs between PwO and HCPs about obesity treatment effectiveness, and low perceived value of employer wellness programs among PwO may also impact successful weight management.”

Among the surveyed PwO, 23 percent reported having lost 10 percent of their body weight within the previous three years. Of those people, 44 percent reported maintaining the weight loss for more than one year.

However, that group represents just 10 percent of the study sample, and most doctors recommended obese individuals lose 20 percent of their body weight, not half that amount.

“Obesity pathophysiology and management are often absent from health professional school curricula, rendering most HCPs ill equipped to address this problem,” Kaplan and colleagues wrote. “HCPs often recognize this limitation, but there are few incentives to remedy it. Exacerbating the problem, effective treatment of obesity is challenging, time-consuming, and poorly reimbursed, for both provider and patient.

“In the face of a large professional information gap, myths and misinformation abound. The perceptions and behaviors observed in this study reveal a broad, unmet opportunity to educate HCPs, PwO, (employer representatives), and other stakeholders about the biology of obesity and the opportunity, value, and need of professional health care-based interventions.”