Seeking Real Obesity Care, Not Just Weight Loss

Right now, it’s getting much easier to find medical help with weight loss, but finding real obesity care remains more challenging. In fact, a new paper by Lauren Oshman and colleagues tells us that less than ten percent of primary care providers (PCPs) in a sample from an academic health system actually use evidence-based guidelines for clinical care in obesity.

Should we be surprised? Oshman et al say we should not:

“The majority (92.5%) of survey participants reported only using clinical judgement – rather than clinical practice guidelines – when treating patients with obesity. This is consistent with prior work suggesting that PCPs may not fully recognize inconsistencies between their own obesity treatment practice patterns and guideline recommendations.”

Time, Money, and Priorities

In Oshman’s work, the barriers to delivering real obesity care were pretty clear. Time, money, and priorities rose to the top of the list reported by these PCPs. Patients have other, more urgent concerns. Visits are short and insurance doesn’t always cover this kind of care.

A subplot in these reports from PCPs reflected a misunderstanding of obesity care. Almost half or respondents said things like losing weight is not a priority for the patient, available weight loss strategies are ineffective, or they already know what to do. In other words, when these clinicians think about obesity care, their thoughts go almost exclusively to losing weight. Not gaining health.

Setting Goals to Gain Health

This perspective is not so different from the patient population these PCPs encounter. Most people living with obesity reject that word. In a 2015 study, we found that 86 percent of people with class 1 obesity reject the diagnosis of obesity for themselves. They’re merely overweight. Even for people with class 3 (severe) obesity, barely half believe that obesity is an accurate description for their condition. So most people either tell themselves they would like to lose weight or that losing weight is pointless because this is just how they are.

But that still leaves a substantial number of people who really are ready to set longer-term goals for improving their health. These are the people for whom real obesity care can matter far more than mere weight loss.

Opportunity for Better Care

Despite the current deficits in care, Oshman and colleagues see an opportunity because PCPs know that obesity care should be a priority:

“Almost all participants agreed or strongly agreed that their PCP colleagues consider obesity treatment to be a priority (n = 90, 84.1%) and a majority reported that their clinical leadership considers obesity treatment to be a priority (n = 67, 62.6%).

They found substantial interest in obesity medicine – 39 percent of respondents said they would like to obtain certification. But the substantial barriers remain because it takes time and money to get that certification. Health systems and health policy will need to adapt and knock down those barriers.

Otherwise, the pursuit of short-term weight loss will continue to crowd out opportunities for better long-term health in people who are ready to seek it.

Click here for the study by Oshman et al and here for further perspective.

Pilgrimage to the Cedars in Lebanon, painting by Tivadar Csontváry Kosztka / Wikipedia

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April 25, 2023