Effective obesity management requires recognizing barriers, long-term treatment

Many patients with obesity report experiencing barriers to care, but primary care physicians can address these barriers through comprehensive management, according to two speakers at the Obesity Medicine Association 2021 virtual conference.

“Despite changing attitudes towards obesity and its increasing recognition as a chronic, serious and progressive disease, many barriers to effective care remain,” Leah D. Whigham, PhD, FTOS, an associate professor in the department of health promotion and behavioral sciences and the director of the Center for Community Health Impact at the University of Texas Health Science Center, said during a presentation. “These barriers are reflected in the insufficient interaction between patients and health care professionals relating to dialogue and treatment of obesity.”

According to Whigham, there are five key barriers to obesity care: challenges in maintaining weight loss; inaccurate perceptions of wellness programs; reluctance to seek help; insufficient diagnosis; and inadequate dialogue and follow up. She cited data from the ACTION study that showed 72% of surveyed providers reported a sense of responsibility to contribute to patients’ weight loss efforts, but 82% of patients reported that they considered weight loss to be completely their own responsibility. The study also revealed that only 55% of surveyed patients reported having a formal diagnosis of obesity, 38% reported discussing a weight loss plan with their health care provider and 24% reported making a follow-up appointment.

But, Whigham said, there is an opportunity for health care providers to close this gap and address obesity with their patients: 54% of patients reported they completely agreed that losing weight was a high priority and 40% said they completely agree that they were motivated to lose weight.

Nonetheless, interventions must be based on evidence and tailored to the individual. Well-intentioned, but too general, suggestions such as eating in moderation, eating more fruits and vegetables, avoiding fried foods and increasing physical activity are “ineffective,” according to Nik V. Dhurandhar, LCEH, MS, PhD, FTOS, a professor and Helen Devitt Jone Endowed Chair of the department of nutritional sciences at Texas Tech University.

“The right message for patients is obesity is a chronic disease,” Dhurandhar said during the presentation.

Therefore, obesity requires comprehensive management, which Dhurandhar breaks down into three parts: treatment of comorbidities such as diabetes; treatment of obesity through lifestyle modification, activity, diet, drugs and surgery; and prevention of weight regain, which is an ongoing issue for patients.

“When we are treating patients, I like to use the word ‘management of obesity’ instead of weight loss because weight loss, as you see there, is a really small — important, but small — component of the whole management of obesity,” Dhurandhar said.