- The Washington Times - Tuesday, November 7, 2017

Nearly two-thirds of U.S. physicians say they don’t discuss weight loss with their obese patients for fear of embarrassing them, according to a survey examining barriers to treatment in the obesity epidemic.

The ACTION survey, published last week in the journal Obesity, is one of only a few studies to compare perceptions of health care providers and obese people on where responsibility lies in treating the debilitating condition, which affects more than 38 percent of Americans.

“Despite increasing consensus that obesity is a serious, complex, and chronic disease with considerable negative impact on individual health and quality of life, as well as a significant societal burden, addressing and treating obesity within the standard medical context are uncommon,” reads the introduction of the survey’s study.

One of its key findings is that 65 percent of health care providers said they don’t address weight management with their patients for fear of embarrassing them, but only 15 percent of patients said they are embarrassed to talk about weight management.

“The issue about physicians not engaging is really what it comes down to, and other health care providers not engaging in the medical care of obesity,” said Dr. Lee Kaplan one of the study’s lead authors and an obesity medicine specialist at Massachusetts General Hospital. “I wouldn’t say it’s surprising, but it’s certainly striking.”

According to the Centers for Disease Control and Prevention, about 70 percent of U.S. adults who are at least 20 years old are overweight or obese.

ACTION stands for Awareness, Care and Treatment In Obesity maNagement. The study was two years in the making by obesity treatment advocates such as the Obesity Society, the Obesity Action Coalition, the Integrated Benefits Institute and specialists in primary care, endocrinology, psychology and nursing.

The study was funded by the drug manufacturer Novo Nordisk Inc., which includes medications and devices for treating diabetes among its products.

Joseph Nadglowski, president of the Obesity Action Coalition, said the study has prompted his organization to emphasize in its educational materials tools to help people discuss weight loss and management with their doctors.

“The assumption is that people are in denial, but actually, if you look at the data, it’s saying their health care providers aren’t diagnosing them,” Dr. Nadglowski said. “There isn’t any other health condition that you ask people to self-diagnose.”

The ACTION survey collected data over a 13-day period in 2015 from three groups: 3,008 obese adults, 606 health care professionals and 153 employee representatives in charge of their companies’ wellness programs.

Each group was given a specific set of questions, and each set centered on a theme, such as whether obesity is a disease, the seriousness of its health effects and who is responsible for treating it.

All respondents defined as obese patients self-reported a body mass index (BMI) of 30 or higher, which falls within obesity parameters, but only 55 percent said they ever received a formal diagnosis from a medical provider.

But only half of those respondents said they perceive themselves as obese — with 48 percent saying they are overweight and 2 percent saying they are normal weight.

What’s more, 65 percent of the respondents said obesity is a disease but only 54 percent worried that their weight might affect their future health.

Between patients and health care providers, 82 percent of obese respondents said weight management was their burden alone, yet 72 percent of providers felt responsible for their patients’ weight loss efforts.

“Society has spent the last 50 years blaming the patients for their own disease here,” Dr. Kaplan said. “Patients listen to that, and providers are also members of society, so they listen to it as well, and so we’ve gotten to the point where we just say this is a personal failing or it’s a moral problem or it’s a psychological issue. But once you recognize that that’s not the case, that there really is something wrong with the body, realize that like every other disease it’s a shared responsibility.”

About 55 percent of health care providers said they don’t feel their patients are motivated to lose weight — the second most cited reason for physicians not discussing weight management.

Dr. Kaplan said other barriers to obesity treatment include not having enough time in an examination room or space for follow-up appointments.

“If it’s 100 million people, just the number of extra visits that would be required to address obesity, providers are already maxed out on their time,” he said.

Likewise, employee representatives said they had little impact or responsibility in helping colleagues lose weight.

While 77 percent said their company has an employee health and wellness program, less than half of those programs had healthy food options and nutrition coaching (44 percent) and even fewer had on-site diet programs (16 percent).

In his own practice, in which Dr. Kaplan is an obesity specialist and gastroenterologist, he said he raises the issue of obesity in a straightforward “but hopefully nonconfrontational way.”

His approach includes evaluating whether the patient’s obesity is caused by environmental factors that are amenable to intervention — such as unhealthy diet, lack of exercise, chronic stress, sleep deprivation or drugs that contribute to obesity. He said treatments include medication and, in a very small population, surgery.

“One of the challenges that is highlighted by the ACTION study is that not considering obesity as a disease has put a damper on research and new therapy development. It’s just another example of what happens when you fail to take it seriously,” he said.

Diet and exercise alone work only for a small percentage of the obese population, Dr. Kaplan said, adding that many other factors can contribute to obesity and need to be addressed.

“The fact that patients take all the responsibility on themselves is nearly indicative that society as a whole hasn’t yet recognized just how severe the biology of obesity is, that it’s a real medical problem,” he said.

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