Around a third of the U.S. population is obese, often with serious adverse health effects (Flegal et al., 2016). Although weight-related counseling by clinicians is effective in leading to weight loss by obese patients (Rueda-Clausen et al., 2014; Wadden et al., 2014; USPSTF, 2012), the weight-related counseling theme that patients most often say they need help with is using food as a coping mechanism (Rand K et al., 2017). Interpersonal themes mentioned frequently are being blamed and shamed by family or friends about weight and feeling criticized rather than supported by their health care providers. Unfortunately, a study found that patients with weight problems perceived that they received weight loss counseling far less often than their providers perceived they did (46% versus 92%) (Rose SA 2013). In other studies, patients struggling with their weight complained about the quality of weight-related interventions from their providers (Kaplan et al., 2015; Torti et al., 2017). It looks like there is room for improvement in clinician-patient communications about weight.
A study of barriers to initiating treatment for obesity, from the perspective of obese patients (n=43) and clinicians (n=23), found that both patients and clinicians understand that obesity is a combination of a disease and lifestyle, and that motivation is a major barrier to weight loss (Kaplan et al., 2015). But there are major differences between patients and clinicians with respect to their perceptions of other barriers to weight loss. Patients perceived each of the following as barriers to weight loss far more often than clinicians:
- Food habits (88% patients vs 38% clinicians)
- Challenges arising from social relationships (79% patients vs 38% clinicians)
- Feeling deprived while dieting (56% patients vs 8% clinicians)
Clinicians, on the other hand, were far more likely than patients to name a lack of patients’ understanding of how to lose weight as a barrier far more often than patients (58% vs. only 9%).
The majority of obese patients in the study (65%) considered obesity to be mainly a lifestyle problem and the majority of clinicians considered obesity to be mainly a disease (Kaplan et al., 2015). A potential reason for patients not being as aware of the disease aspect is that many people who are obese do not realize they have health problems that are related to their obesity:
- 75% of participants with obesity perceived themselves as “healthy”
- 75% of participants had obesity-related comorbid conditions
However, and most importantly, most obese individuals in this study would be motivated to lose weight if they developed health complications of their obesity.
The bottom line is that improving communications with patients about weight-related problems could potentially increase patient motivation to lose weight and turn the trend of the current obesity epidemic plaguing our country.
- Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016; 315(21): 2284-2291
- Kaplan LE, Golden A, O’Neil P, et al. Divergence of patient and clinician perceptions of obesity and weight management. ACTION (Awareness, Care & Treatment In Obesity Management). October, 2015.
- Rand K et al. “It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity. Int J Qual Stud Health Well-being. 2017; 12(1):1306421. doi 10.1080/17482631.2017.1306421.
- Rose SA Screening and management of obesity and perception of weight status in Medicaid recipients. J Health Care Poor Underserved. 2013; 24(2 suppl): 34-46. doi: 10.1353/hpu.2013.0098
- Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, Vallis MT, Sharma AM. Effect of implementing the 5As of Obesity Management framework on provider-patient interactions in primary care: 5As of obesity management in primary care. Clin Obes. 2014;4(1):39–44.
- Torti J, Luig T, Borowitz M, et al. The 5As team patient study: patient perspectives on the role of primary care in obesity management. BMC Fam Pract. 2017;18:19. doi:10.1186/s12875-017-0596-2.
- U.S. Preventive Services Task Force. Screening for and Management of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication No. 11-05159-EF-2. 2012.
- Wadden TA , Butryn ML , Hong PS. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014; 312: 1779-1791.