In the face of the growing obesity epidemic, it is important to understand what barriers exist to effective obesity care, such that we can do better at successfully treating this medical condition.
The ACTION Canada study, in which I was one of the investigators and authors, was just published in the journal Clinical Obesity. ACTION Canada was undertaken to get a better understanding of the barriers to obesity care in Canada. We created an online survey and sent it out to three groups of Canadians: adults with obesity; healthcare providers; and employers who offer health insurance or wellness programs.
Here are some of our key findings:
- More people with obesity felt that obesity has a high impact on health than those who thought cancer would.
- Diet and exercise were felt by both people with obesity, and health care providers, to be the most effective way to treat obesity.
- Most people with obesity feel that they know what they need to do to lose weight (and they said this was diet and exercise);
- However, only 10% of people reported that they had been able to lose 10% of their weight and keep it off for more than a year.
When obesity was NOT getting talked about between patients and their health care providers, the reasons cited were very different:
- People with obesity felt it was their own responsibility to manage their weight and felt they knew what they need to do.
- Health care providers often felt that their patients are not interested in, nor motivated to, lose weight (whereas in truth, 95% of people with obesity said they were interested to lose weight, and 77% felt motivated to do so).
When obesity DID get talked about in a clinical setting, we found a huge gap in what people with obesity vs health care professionals think is happening when they talk about obesity in the office.
- Patients often reported feeling like they were not getting the opportunity to talk about how obesity affects their life, were not getting help to set goals, to contribute to their own treatment plan, were not being offered avenues of support in their treatment journey, and usually not contacted after a visit for ongoing follow up.
- Health care providers reported much more positively on all of these aspects.
Both people with obesity and health care providers had little faith in non-lifestyle treatment approaches (which we know can be very successful, based on robust clinical trial evidence):
- Only 3% of patients and 17% of health care providers thought that antiobesity medications are effective.
- Only 3% of patients felt that bariatric surgery is effective; 43% of health care providers felt that bariatric surgery is effective.
Clearly, there are deep layers of barriers and obstacles to helping people with obesity get effective care. We have people feeling that they shouldn’t turn to their health care providers, feeling they know what they need to do but not having success. We have health care providers thinking their patients are not motivated nor interested to lose weight, which is clearly NOT the case. We have both groups thinking that diet and exercise are the most effective ways to lose weight- while lifestyle changes are key to the success of any obesity treatment journey, studies clearly show that lifestyle change alone usually does not result in long term weight loss success.
We need to work to bring patients and health care providers to a common ground of understanding. Health care providers need to be better educated on obesity treatment options – most have only received as little as one hour (!!) of training on obesity in their entire education and career. The upcoming Canadian Obesity Guidelines will be a great resource for both health care providers and people living with obesity.
Stay tuned for an Obesity Canada report on this important study, coming in October!
Disclaimer: The ACTION study is funded by Novo Nordisk, the maker of anti obesity medication Saxenda (liraglutide 3.0mg). I received honoraria for participation as an investigator in the ACTION study. I receive honoraria as a continuing medical education speaker and consultant from Novo Nordisk.
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