ASMBS/NORC Survey Reveals Opportunities in Reaching the Public/Other Physicians about Obesity and its Current Treatment Modalities
Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.
During ObesityWeek 2016, the American Society for Metabolic and Bariatric Surgery (ASMBS) and NORC, an independent research organization at the University of Chicago, released results from a nationally representative survey aimed to gauge public perception of obesity, its risks, available treatment methods. The survey included 1,509 adults, oversampling African Americans and Hispanics, through interviews conducted between August 11 and September 21, 2016, online and using landlines and cell phones. The headline of the first report gave us a good idea as to what the survey findings revealed, “Obesity Rises to Top Health Concern for Americans, but Misperceptions Persist.”
The following are some survey result highlights:
• 81 percent report obesity as a serious health problem facing the nation, tying with cancer as the most serious issue.
• Nearly all (94 percent) agree that obesity increases a person’s risk of dying early even if they don’t have any other health conditions. However, few (38 percent) consider obesity in and of itself as a disease.
• Losing weight on one’s own through diet and exercise is still perceived to be the most effective long-term weight-loss method (78 percent), higher than weight-loss surgery (60 percent) or prescription medications (25 percent).
• Despite widespread recognition of its severity, more than one-third of those with obesity have not spoken with a doctor or health professional about their weight.
• Losing weight with the help of a doctor through diet or exercise rates the highest in terms of safety (90 percent), while prescription medications (15 percent) and dietary supplements (16 percent) rate the lowest.
• Americans are divided when it comes to the risks of weight-loss surgery, with one-third each believing it to be safe, unsafe, or neither safe nor unsafe. A majority of Americans (68 percent), however, believe that living with obesity is riskier than having weight-loss surgery.
The good news we can glean from these results is that obesity is in fact becoming a recognized disease as the survey shows people rank it as tied with cancer as a top health threat. This represents a big shift from even just one decade ago when obesity was viewed as more of an issue of willpower. I think that we’ve done a better job at medicalizing obesity as a whole; however, this survey tells us that on an individual basis, we aren’t there yet.
This survey brings to light a big barrier: many individuals are actually underestimating their body mass index. Fifty-seven percent of Americans whose calculated BMI placed them in the obesity range said that they do not consider themselves to have obesity. Forty-seven percent considered themselves to be overweight but not obese and nine percent consider their weight to be about right. This tells us that there are likely a lot of people out there who don’t realize they would be great candidates for available therapies like pharmacotherapy and surgery. Equally interesting is what this data tells us about the public’s perception of obesity treatment modalities.
“Losing weight with the help of a doctor through diet or exercise rates the highest in terms of safety (90 percent), while prescription medications (15 percent) and dietary supplements (16 percent) rate the lowest.”
When you review these numbers, you have to wonder if they are thinking of the old days of obesity medications. This illustrates a need to educate the public about the current available obesity medications and data, driving home the message that these have been shown to be safe and effective in not only losing weight but also keeping it off. We should also reiterate to the public that a 5 to 10 percent weight loss goal (through behavior modification, medication, endoscopic therapies) is achievable and important in improving comorbid conditions.
These survey findings also reveal a need to educate primary care and referring physicians on the disease of obesity AND how to treat it. I think that although many physicians view it as a disease, a lot of them don’t have the knowledge or tools to help treat it. It’s such a chronic relapsing disease—the recidivism is so high and the epidemic of obesity is so great that perhaps physicians just chose to not address it at all. They may just treat all the other comorbid medical problems with the disease of obesity lingering as the white elephant in the exam room.
Another big factor in primary care and referring physicians addressing obesity with their patients may be time constraints. I believe we are getting better at spreading the message of how to evaluate and treat patients with obesity even in a 10-minute office visit. We have seen improvement of physician education through the following:
• Continued certification of Obesity Medicine Specialists through the American Board of Obesity Medicine.
• Availability of obesity algorithms
• Obesity Medicine Association (OMA) has published an Obesity Algorithm 2016
• American Heart Association/American College of Cardiology/The Obesity Society) 2013 Guideline for the Management of Obesity in Adults
• The Endocrine Society: Pharmacological Management of Obesity
• 2016 AACE/ACE Clinical Practice Guidelines
• Press coverage of weight loss modalities and their medical benefits. In fact, this survey was picked up by major news networks, including The New York Times, People, Cosmopolitan, and International Business Times, thus extending reach and awareness.
• Weight loss being secondary to profound medical benefits being observed through multiple treatment modalities (e.g., diet, exercise, pharmacotherapy, endoscopic devices, surgery)
The main opportunities I envision coming out of this survey are the following:
1. Focus on educating patients and the general public on frequently evaluating their BMIs to determine stages of the obesity disease.
2. Relay to patients, the public, and the medical community that there are safe and effective treatment methods available to help them.
3. Continue reaching our colleagues in primary care and other disciplines, teaching and encouraging them how to 1) evaluate patients with obesity and comorbid conditions and 2) steer them to treatment.
I’d like to commend the ASMBS for funding and initiating this important project from which we can all use to learn more and identify opportunities in treating patients with obesity. Everybody has a piece of this pie and we can work together to make treatment of this chronic and relapsing disease better and more utilized.
Christopher Still, DO, FACN, FACP
1. American Society for Metabolic and Bariatric Surgery (ASMBS), NORC at the University of Chicago. Obesity Rises to Top Health Concern for Americans, but Misperceptions Persist. October 2016. http://www.norc.org/PDFs/ASMBS%20Obesity/Issue%20Brief%20A_ASMBS%20NORC%20Obesity%20Poll.pdf. Accessed December 1, 2016.
2. American Society for Metabolic and Bariatric Surgery (ASMBS), NORC at the University of Chicago. New Insights into Americans’ Perceptions and Misperceptions of Obesity Treatments, and the Struggles Many Face. http://www.norc.org/PDFs/ASMBS%20Obesity/Issue%20Brief%20B_ASMBS%20NORC%20Obesity%20Poll.pdf. Accessed December 1, 2016.
3. Kolata G. Americans Blame Obesity on Willpower, Despite Evidence It’s Genetic. The New York Times. November 1, 2016. http://www.nytimes.com/2016/11/01/health/americans-obesity-willpower-genetics-study.html?_r=0. Accessed December 1, 2016.
4. Kimble L. Having Trouble Losing Weight? Obesity Is Due to Genetics — Not Lack of Willpower — Researchers Say. People Bodies. November 2, 2016. http://people.com/bodies/having-trouble-losing-weight-obesity-is-due-to-genetics-not-lack-of-willpower-researchers-say/. Accessed December 1, 2016.
5. Narins E. It’s Really Not Your Fault If You’re Overweight: So stop feeling awful when your diet doesn’t work. Cosmopolitan. http://www.cosmopolitan.com/health-fitness/a8075771/willpower-wont-solve-your-weight-issues/. Accessed December 1, 2016.
6. Jha N. Americans blame obesity on laziness and lack of willpower, says study. International Business Times. November 3, 2016. http://www.ibtimes.co.in/americans-blame-obesity-laziness-lack-willpower-says-study-702379. Accessed December 1, 2016.