Misperceptions and barriers to obesity management: Italian data from the ACTION-IO study

Paolo Sbraccia, Luca Busetto, Ferruccio Santini, Mariarosaria Mancuso, Paolo Nicoziani, Antonio Nicolucci, Paolo Sbraccia, Luca Busetto, Ferruccio Santini, Mariarosaria Mancuso, Paolo Nicoziani, Antonio Nicolucci

Abstract

Purpose: Despite the increasing prevalence of obesity in Italy, it remains largely underdiagnosed and undertreated. We aimed to identify the perceptions, attitudes, behaviours and barriers to effective obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in Italy.

Methods: The ACTION-IO study was an online cross-sectional survey conducted in 11 countries from June to October 2018. Findings from the Italian cohort are reported here.

Results: The survey was completed by 1501 PwO and 302 HCPs in Italy. Most PwO (84%) and HCPs (77%) acknowledged the large impact of obesity on overall health. However, fewer PwO (62%) than HCPs (91%) perceived obesity as a chronic disease. Most PwO (84%) assumed full responsibility for their weight loss. A median of 3 (mean 6) years elapsed between when PwO started struggling with obesity and when they first discussed their weight with an HCP. Many PwO expressed that they liked (80%) or would like (74%) their HCPs to initiate weight management conversations, and only 3% were offended by such a conversation. For 77% of HCPs, perceiving their patients as unmotivated or disinterested in losing weight prevented them from initiating these conversations. Short appointment times were also considered a limiting factor for 40% of HCPs.

Conclusions: Most PwO took complete responsibility for their own weight loss and waited considerable time before seeking help from an HCP. There is a need for improved education of both PwO and HCPs and for a more positive attitude from HCPs towards initiating weight discussions with PwO. Trial registration ClinicalTrials.gov: Awareness, Care & Treatment in Obesity Management - an International Observation (ACTION-IO). ClinicalTrials.gov: NCT03584191 LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Keywords: Attitude; Healthcare professionals; Italy; Obesity; Obesity care; Perception.

Conflict of interest statement

Dr. Sbraccia reports grants from Novo Nordisk during the conduct of the study. Dr. Busetto reports grants from Enzymmanagement AG, personal fees from Novo Nordisk, and personal fees from Bruno Farmaceutici S.p.A., outside the submitted work. Dr. Santini reports personal fees and participation in this trial from Novo Nordisk, and personal fees from BrunoPharma, personal fees from Aegerion, participation in clinical trials with Damor Pharmaceuticals, grants from BioItalia S.p.A., outside the submitted work. Dr. Mancuso and Dr. Nicoziani are Novo Nordisk employees. Dr. Nicolucci reports grants from Novo Nordisk, during the conduct of the study.

Figures

Fig. 1
Fig. 1
PwO and HCP agreement with statements regarding attitudes towards obesity, rated on a scale of 1–5. HCPs = grey; PwO = blue. HCP healthcare professional, PwO people with obesity
Fig. 2
Fig. 2
Weight loss attempts and maintenance. PwO extent and maintenance of weight loss in the past 3 years at a threshold of (a) 5% or (b) 10% of total body weight. PwO people with obesity
Fig. 3
Fig. 3
Attitudes towards weight management conversations. a Proportion of PwO having weight management discussions, obesity diagnoses, and follow-up appointments/calls with HCPs. b Time between first struggle with weight and having a weight management conversation with HCPs. c Proportion of PwO who like or would like their HCP to initiate weight discussions during appointments. d Feelings of PwO following weight discussions with an HCP. HCP healthcare professional, PwO people with obesity
Fig. 4
Fig. 4
Most important weight management goals to personally achieve by PwO. PwO people with obesity
Fig. 5
Fig. 5
Effective long-term weight management recommendations by HCP. HCP healthcare professional
Fig. 6
Fig. 6
Reasons for not discussing weight with an HCP (PwO, blue) or patient (HCPs, grey); reasons with at least 10% difference between PwO and HCPs are above the dotted line, all others are below the dotted line. Respondents selected their top 5 reasons from the list of options. HCP healthcare professional, PwO people with obesity

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