Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study

Abstract

Objectives: To investigate the perceptions, attitudes, behaviours and potential barriers to effective obesity care in the UK using data collected from people with obesity (PwO) and healthcare professionals (HCPs) in the Awareness, Care, and Treatment In Obesity maNagement-International Observation (ACTION-IO) study.

Design: UK's PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and HCPs who manage patients with obesity completed an online survey.

Results: In the UK, 1500 PwO and 306 HCPs completed the survey. Among the 47% of PwO who discussed weight with an HCP in the past 5 years, it took a mean of 9 years from the start of their struggles with weight until a discussion occurred. HCPs reported that PwO initiated 35% of weight-related discussions; PwO reported that they initiated 47% of discussions. Most PwO (85%) assumed full responsibility for their own weight loss. The presence of obesity-related comorbidities was cited by 76% of HCPs as a top criterion for initiating weight management conversations. The perception of lack of interest (72%) and motivation (61%) in losing weight was reported as top reasons by HCPs for not discussing weight with a patient. Sixty-five per cent of PwO liked their HCP bringing up weight during appointments. PwO reported complex and varied emotions following a weight loss conversation with an HCP, including supported (36%), hopeful (31%), motivated (23%) and embarrassed (17%). Follow-up appointments were scheduled for 19% of PwO after a weight discussion despite 62% wanting follow-up.

Conclusions: The current narrative around obesity requires a paradigm shift in the UK to address the delay between PwO struggling with their weight and discussing weight with their HCP. Perceptions of lack of patient interest and motivation in weight management must be challenged along with the blame culture of individual responsibility that is prevalent throughout society. While PwO may welcome weight-related conversations with an HCP, they evoke complex feelings, demonstrating the need for sensitivity and respect in these conversations.

Trial registration number: NCT03584191.

Keywords: epidemiology; general medicine (see internal medicine); medical education & training; public health.

Conflict of interest statement

Competing interests: CAH 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, Ethicon and Alva outside the submitted work. ALA reports grants from UKRI Medical Research Council and National Institute for Health Research, and non-financial support from WW (formerly Weight Watchers). HK is an employee of Novo Nordisk and owns shares in Novo Nordisk. BMM reports grants paid to her institution from Novo Nordisk and personal fees (consultancy and advisory board) from Novo Nordisk, Boehringer Ingelheim and Orexigen Therapeutics; and has received speaker fees for Eli Lilly, Novo Nordisk, Boehringer Ingelheim, Janssen, MSD and Sanofi. HMP reports grants from the National Institute for Health Research and Public Health England and an honorarium from Novo Nordisk (educational grant) outside the submitted work. AV acted as a speaker for Obesity Empowerment Network and is a board member of the Clinical Advisory Committee on the All Wales Obesity Strategy. JCGH reports fees (honoraria) paid to the University of Liverpool from Novo Nordisk, Orexigen and Boehringer Ingelheim during the conduct of the study.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Number of years between when struggle with weight began and first discussed with an HCP and PwO/HCP reasons for not discussing weight management. (A) Approximate number of years reported by the UK and global PwO (ACTION-IO study steering committee, personal communication) between the beginning of their struggle with weight and first discussion with an HCP. Calculated at respondent level from questions, ‘Approximately how old were you when you first remember struggling with excess weight or obesity?’ and ‘Approximately how old were you when a healthcare provider first discussed your excess weight or recommended that you lose weight?’. (B) Reasons reported by the UK’s PwO for not discussing managing their weight with an HCP. (C) Reasons reported by the UK’s HCPs for not discussing weight management with their patients. ACTION-IO, Awareness, Care, and Treatment In Obesity maNagement–International Observation; HCP, healthcare professional; PwO, people with obesity.

Figure 2

Sources of information and feelings after a weight discussion. (A) Sources of information most frequently used by the UK’s PwO for managing weight (reported by PwO). (B) Feelings reported by the UK’s PwO after their most recent weight or weight loss discussion with an HCP in the past 5 years. HCP, healthcare professional; PwO, people with obesity.

Figure 3

Obesity diagnoses and follow-up appointments with an HCP. Proportion of the UK’s PwO who discussed weight or weight loss with an HCP in the past 5 years and the frequency of obesity diagnoses and follow-up appointments. HCP, healthcare professional; PwO, people with obesity.

Figure 4

A conceptual model of the obesity treatment pathway and barriers to obesity care in the UK. BMI, body mass index; HCP, healthcare professional; PwO, people with obesity.