ACTION-IO as a platform to understand differences in perceptions, attitudes, and behaviors of people with obesity and physicians across countries - the Israeli experience

Abstract

Background: Obesity is a highly prevalent, complex, and chronic relapsing disease with a considerable unmet medical need. We aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity treatment among people with obesity (PwO) and physicians in Israel.

Methods: The ACTION-IO study was an online survey conducted in 11 countries, including Israel. Findings from the Israeli cohort are reported here. Israeli respondents were PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and physicians primarily in direct patient care.

Results: In total, 750 PwO and 169 physicians completed the survey in Israel. Although most PwO (70%) and physicians (95%) perceived obesity as a chronic disease, the majority of PwO assumed full responsibility for their own weight loss (88%) compared with only 19% of physicians who placed the responsibility for weight loss on their patients with obesity. Many PwO (62%) and physicians (73%) agreed that a complete change in lifestyle would be required for PwO to lose weight and felt that treatment of obesity should be a team effort between different healthcare professionals (HCPs; 80 and 90%, respectively). Dietitians were considered by 82% of physicians to be the most effective professionals in helping PwO achieve their weight loss goals. Many PwO (69%) liked that their HCP initiated weight management discussions and 68% of those who had not previously discussed their weight would like their HCP to initiate the conversation. However, among PwO who had discussed their weight with an HCP, 59% considered the discussions to be a little helpful or not at all helpful. The beliefs that patients have little interest in or motivation for losing weight were identified by physicians as the main reasons (71 and 70%, respectively) for not initiating weight management discussions.

Conclusions: In line with the ACTION-IO international study, our Israeli dataset reveals a need to improve awareness, primarily among physicians, on the physiologic basis and clinical management of obesity, including how to approach weight and weight management discussions during patient consultations.

Trial registration: Registered at ClinicalTrials.gov , NCT03584191 . Data first posted on ClinicalTrials.gov : 12 July 2018 - 'Retrospectively registered'.

Keywords: ACTION-IO; Barriers; Israel; Obesity; Perceptions.

Conflict of interest statement

D. D. reports personal fees for medical lectures and consultations from Novo Nordisk, during the conduct and steering of the study, and personal fees for medical lectures and consultations from Teva, outside the submitted work. N. S. reports personal fees for medical lectures from Novo Nordisk, Eli Lilly, Boehringer Ingelheim and Sanofi, personal fees for consultations from Novo Nordisk, Eli Lilly, Boehringer Ingelheim and Sanofi, and grants for supporting patient and staff education from Novo Nordisk, Eli Lilly, Boehringer Ingelheim and Sanofi, outside the submitted work. S. P.-Y. was an employee of Novo Nordisk during study conduct and manuscript development. B. K., R. B. and G. S.-L. disclose no conflicts of interest.

Figures

Fig. 1

PwO and physician agreement with statements about obesity and weight management. Rated on a scale of 1–5. Physicians = green; PwO = orange. n size for PwO is less than total due to respondents selecting not sure for attributes. Abbreviation: PwO, people with obesity

Fig. 2

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

Fig. 3

Weight loss efforts and response to intervention. a Number of past serious weight loss attempts (PwO). b Proportion of patients considered to have made a serious weight loss attempt reported by physicians. c, d PwO extent and maintenance of weight loss in last 3 years at threshold of (c) 5% or (d) 10% of total body weight. Physicians = green; PwO = orange. Abbreviation: PwO, people with obesity

Fig. 4

Weight management conversations and outcomes. a Proportion of PwO having weight management discussions with an HCP, obesity diagnoses and follow-up appointments/calls. b Of PwO who had discussed their weight with an HCP in 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 started struggling with their weight. c PwO feelings after discussing their weight with an HCP. d Proportion of PwO who like or would like their HCP to bring up weight during appointments. Abbreviations: HCP, healthcare professional; PwO, people with obesity

Fig. 5

Reasons for not discussing weight with an HCP or patient, with at least 10% difference. Reasons for not discussing weight with an HCP (PwO responses) or patient (physician responses) with at least 10% difference between PwO and physicians. See Supplementary Figure S1 (Additional file 1) for all reasons. Physicians = green; PwO = orange. Abbreviations: HCP, healthcare professional; PwO, people with obesity