Are Health Care Providers Doing Enough for Patients with Obesity?

Dr Angela K Golden of the ACTION study

Angela Golden, DNP, FNP-C, FAANP

Patients with obesity Obese patients may not being getting the care they need despite the expanding recognition of the condition and the staggering 90 million Americans who are obese.

More than half of obese patients that have spoken with a health care professional about their weight have been given a diagnosis, and less than one quarter were offered any type of follow-up care, according to data presented at ObesityWeek in Washington, DC.

The Awareness, Care, and Treatment In Obesity Management (ACTION) study found that 71% of patients with obesity (PwO) have reported speaking to a health care provider (HCP) about their weight, but only 55% have been given a proper diagnosis. Within that 55%, only 24% have been offered some type of care for their condition.

"We in the health care community must ask why this epidemic is not being diagnosed and treated with the same urgency and focus as any other serious diseases?" Lee Kaplan, MD, director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital, ACTION steering committee member, and lead author of the study, said in a statement. "We need to fundamentally rethink obesity so that the public and health care community understand more about the biology, chronicity and overall health impact of this disease. Real progress can be achieved if we can overcome the entrenched mindsets that generate the barriers revealed by this study."

One of the bigger challenges brought up by the study data involved the clinical discussions being had between patients and physicians. According to the results, the majority (77%) of HCP discussed general improvement of eating habits compared to 23% developing a specific diet program. These results were mirrored with exercise strategies, with 79% of HCPs suggesting an increase in activity, compared to 24% helping develop a formal exercise program.

Behavior modification and specialist visits were also discussed at lower rates, with 25% of HCPs recommending a visit with a nutritionist or dietician, and 10% and 9% suggesting therapy for lifestyle modification and visiting a weight loss specialist, respectively.

"The barriers identified in the study highlight opportunities to bridge gaps in understanding to facilitate true collaboration among all stakeholders," Angela Golden, DNP, FNP-C, FAANP, a study co-author and ACTION steering committee member, and owner of a specialty obesity practice in Arizona, said in a statement. "Only by bridging these gaps will obesity care become integral to standard practice, whether in a health care or employment setting, and will people with obesity have the care and support needed to effectively treat their obesity."

ACTION included 3008 PwO, with a mean age of 54 years and a mean body mass index (BMI) of 37. The study also included 606 HCPs that see at least 50% of patients for weight management, including primary care physicians (n = 502) and obesity specialists (n = 104). The two groups were surveyed about their attitudes, experiences, and behaviors involved with obesity management.

While 82% of PwO and 72% of HCPs agreed that they held responsibility for weight loss for themselves or their patients, only 11% of the patients (n = 331) had experienced successful weight loss, defined as a loss of 10% of body weight kept off for at least 12 months. On the other hand, 89% of PwO (n = 2677) experiences no successful weight loss.

The study authors identified that while HCPs felt they were responsible for aiding weight loss, a large majority of PwO feel they are solely responsible, making this a big challenge for obesity patients that want to lose weight. The data supported the idea that being diagnosed with obesity is an important factor in weight loss success.

Within the study population, 1655 patients were actively seeking treatment for obesity (55%), while 1353 were not (45%). Of those 1655 patients seeking treatment and the 331 patients that had experienced successful weight loss, 57% and 51%, respectively, reported having received a diagnosis of obesity, compared with 69% and 53% of their counterparts (P <.05).

The survey revealed that most PwO feel comfortable with speaking about their weight with their HCP (62%), and of the 2185 who had spoken to an HCP, 56% trusted their HCP’s advice, 55% felt their HCP carefully heard their concerns, and 51% felt their HCP understood the difficulties of weight management.

ACTION concluded by recommending that HCPs initiate discussions about weight loss, ensure that weight loss attempts are recognized, as well as scheduling follow-up appointments, and formally diagnosing obesity. Individualized treatment discussions were also highly recommended.