Amer­i­cans aren’t com­pre­hend­ing their obesity

Sur­vey shows many doctors don’t ad­dress prob­lem; patients don’t grasp dan­gers

Baltimore Sun Sunday - - NEWS - Melissa Healy

Nearly 40 per­cent of Amer­i­can adults and 20 per­cent of chil­dren carry enough ex­tra weight to war­rant a di­ag­no­sis of obesity. That’s the high­est obesity rate among the world’s af­flu­ent na­tions, and it’s al­ready short­en­ing Amer­i­cans’ life­spans by driv­ing up rates of di­a­betes, heart dis­ease, stroke, can­cers, arthri­tis and de­men­tia.

If that con­sti­tutes an ur­gent threat to the na­tion’s health, you’d scarcely know it from read­ing the re­sults of a newly pub­lished sur­vey called AC­TION.

The new poll paints a pic­ture of obese adults who are clue­less and feel ut­terly on their own when it comes to los­ing weight and of physi­cians who are of­ten too busy or too ill-equipped to help them.

The na­tion’s obesity cri­sis has been roughly four decades in the mak­ing. The AC­TION re­port is a hum­bling re­minder that, at this rate, it will not be quickly re­versed.

AC­TION stands for Aware­ness, Care and Treat­ment in Obesity Man­age­ment. Dur­ing two weeks in the fall of 2015, sur­vey-tak­ers as­sessed how obesity was viewed, ex­pe­ri­enced and treated by 3,008 obese adults and 606 doctors who pro­vide medical care to such patients.

What they found is a medical es­tab­lish­ment still nav­i­gat­ing its role in ad­dress­ing obesity, and a pop­u­la­tion of patients not yet sure they need — or have a right to de­mand — help in shed­ding ex­tra pounds. The re­sults were pre­sented at this week’s meet­ing of the Obesity So­ci­ety and pub­lished in the jour­nal Obesity.

The Amer­i­can Medical As­so­ci­a­tion for­mally rec­og­nized obesity as a “dis­ease” in June 2013. That medical con­sen­sus has not fully pen­e­trated the ranks of doctors: Only 80% stated they be­lieve obesity is a dis­ease, and only 72% said they have a re­spon­si­bil­ity to ac­tively con­trib­ute to their patients’ weight loss.

Aware­ness among patients with obesity was even worse. Some 65% of obese patients said they be­lieved obesity was a dis­ease that war­ranted com­pas­sion­ate treat­ment. But only 54% said a per­son’s weight would af­fect his or her fu­ture health “a lot” or an “ex­treme amount.”

Strik­ingly, only half of those with obesity ac­tu­ally per­ceived them­selves as “obese” or “ex­tremely obese.” Among the rest, 48% con­sid­ered them­selves “over­weight” and 2% be­lieved they were “nor­mal weight.”

Small won­der per­haps, since only 71% said they had dis­cussed their weight with their doc­tor in the last five years, and only 55% re­ported they had been di­ag­nosed with obesity. Just 24% were of­fered fol­low-up care meant to treat their obesity, and 18% had com­mit­ted to a weight-loss plan.

Even among those who had spo­ken with their doctors about their weight in the last six months, just 26% said they had com­mit­ted to a weight-loss plan.

If patients felt they de­served more help from their doctors, they didn’t say so. Fully 82% be­lieved that man­ag­ing their weight was “com­pletely their own re­spon­si­bil­ity.” And among obese re­spon­dents who had not sought weight-loss help from their doc­tor, this “it’s on me” be­lief was among the top two rea­sons cited.

Most doctors, mean­while, know the stakes. More than half said they con­sid­ered obesity “at least as se­ri­ous” a health con­di­tion as high blood pres­sure, di­a­betes and con­ges­tive heart fail­ure.

But 1 in 3 doctors who treat obese patients said they wait for the patients to broach the sub­ject. Only 1 in 3 re­ported be­ing “some­what com­fort­able” or “a lit­tle com­fort­able” rais­ing the is­sue.

Asked why patients don’t al­ways seek their help, 65% of doctors posited that they were “too em­bar­rassed to bring it up.” Only 15% of patients shared this view.

For their part, doctors fre­quently blamed time lim­i­ta­tions for their fail­ure to di­ag­nose or treat obesity. Asked why they might not ini­ti­ate dis­cus­sions about weight loss, 52% cited “lack of time/the ap­point­ment was not long enough,” and 45% pleaded that they had to deal with “more im­por­tant is­sues and con­cerns.”

The sit­u­a­tion may sound bad, but Har­vard en­docri­nol­o­gist Dr. Lee Ka­plan said he sees signs of progress.

“There’s evidence in here that the health care com­mu­nity and em­ployer com­mu­nity rec­og­nize the se­ri­ous­ness of obesity,” said Ka­plan, a coau­thor of the study.

Still, he added, doctors’ com­mit­ment to treat­ing obesity “as you would any other dis­ease” is not where it should be.

Many doctors are dis­cour­aged by the lim­ited avail­abil­ity of ef­fec­tive treat­ments and won­der why they should bother, Ka­plan said. He added that obesity has be­come so com­mon that they fear “if they open up their prac­tice to obesity treat­ment, they’ll be over­whelmed.”

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