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.

Keywords: ACTION-IO; attitudes; barriers; international; obesity; perceptions.

Conflict of interest statement

All authors received funding for travel expenses from Novo Nordisk to attend author meetings during the conduct of the study. I. D. C. reports personal fees from Novo Nordisk (as chair of the ACTION‐IO steering committee) during the conduct of the study, grants from Novo Nordisk, Bristol‐Myers Squibb, Pfizer and Australian Eggs outside the submitted work, and personal (lecture) fees from Servier Laboratories and Novo Nordisk outside the submitted work. A. A. reports financial support from Novo Nordisk to attend an obesity conference during the conduct of the study, and personal (consultancy) fees and non‐financial support from Novo Nordisk outside the submitted work. W. C. reports personal (consultancy and speaker) fees from Novo Nordisk, EMS, Germed Pharma and Janssen Pharmaceutica outside the submitted work. A. C. reports personal fees from Abbott, Novo Nordisk, Teva Pharmaceutical Industries and Saval Pharmaceuticals during the conduct of the study; she is a member of the Strategic Centre for Obesity Professional Education (SCOPE) of the World Obesity Federation and a SCOPE International Fellow. D. D. reports personal (consultancy and speaker) fees from Novo Nordisk during the conduct of the study and personal (consultancy and speaker) fees from Novo Nordisk and Teva Pharmaceutical Industries outside the submitted work. C. H. reports financial support from Novo Nordisk to attend an obesity conference during the conduct of the study, grants from the Rona Marsden Fund at Fakenham Medical Practice and personal fees from Orexigen Therapeutics, Consilient Health, Nestlé and Ethicon outside the submitted work; she was previously a member of the World Obesity education committee, is a current member of the Association for the Study of Obesity (ASO) and is involved in meetings to facilitate recognition of obesity as a disease in the UK. R. N. reports financial support from Novo Nordisk to attend an obesity conference during the conduct of the study, and personal (consultancy and speaker) fees from Novo Nordisk outside the submitted work. G. R. reports personal (consultancy) fees from Apollo Endosurgery (previously known as Allergan), Medtronic (previously known as Covidien), mdBriefCase Global & Australia, NSW Health and the Australian Department of Health, personal fees and non‐financial support (consultancy/meetings and travel expenses) from the Royal Australian College of General Practitioners (RACGP), Novo Nordisk and iNova Pharmaceuticals outside the submitted work; she is Chair of the RACGP Obesity Management Network. J. S. reports personal (consultancy) fees from Novo Nordisk outside the submitted work. P. S. reports personal fees from Novo Nordisk during the conduct of the study. V. V. V. reports personal fees and non‐financial support from Novo Nordisk during the conduct of the study. J. H. reports personal fees (honoraria) from Novo Nordisk during the conduct of the study. P. A., R. R. and N. R. are employees of Novo Nordisk, and N. R. and R. R. own shares in Novo Nordisk. M. I. and J.‐H. K. disclose no conflits of interest.

© 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Figures

Figure 1

PwO and HCP agreement with statements regarding attitudes towards obesity. Rated on a scale of 1–5. HCPs = green; PwO = orange. Abbreviations: HCP, healthcare professional; PwO, people with obesity

Figure 2

Weight loss efforts and response to intervention. A, Number of previous serious weight loss attempts (PwO). B, Proportion of patients considered to have made a serious weight loss attempt reported by HCPs. C,D, PwO extent and maintenance of weight loss in previous 3 years at threshold of C, 5% or D, 10% of total body weight. HCPs = green; PwO = orange. Abbreviations: HCP, healthcare professional; PwO, people with obesity

Figure 3

Weight management conversations and outcomes. A, Proportion of PwO having had weight management discussions with an HCP, obesity diagnoses and follow‐up appointments/calls. B, Of PwO who had discussed their weight with an HCP during the past 5 years, proportion who had the discussion less than 2 years, 3–5 years, 6–10 years or more than 10 years after they first began struggling with their weight. C, Proportion of PwO who like or would like their HCP to bring up weight during appointments. D, PwO feelings after discussing their weight with an HCP. Abbreviations: HCP, healthcare professional; PwO, people with obesity

Figure 4

Reasons for not discussing weight with an HCP (PwO, orange) or patient (HCPs, green), with at least 10% difference between PwO and HCPs. See Supporting Information Figure S15 for all reasons. HCPs = green; PwO = orange. Abbreviations: HCP, healthcare professional; PwO, people with obesity