Nine Years Before People Receive Medical Help for Their Obesity in the UK

Becky McCall

September 07, 2020

UK healthcare professionals lag behind most other countries worldwide in acceptance of obesity as a disease, while patients with obesity wait an average of 9 years before seeking help, shows a large international study.

Results of the UK analysis of the ACTION-IO study were presented at the virtual European and International Conference on Obesity (ECOICO) 2020. Professor Jason Halford, PhD, head of the School of Psychology at the University of Liverpool, and co-investigator of the survey spoke to Medscape News UK about the UK findings.

"This delay means it’s 9 years of struggle before people with obesity even get to discuss their obesity in an appointment," Prof Halford stressed, adding, "and then they face the problem that UK healthcare practitioners do not consider obesity a disease in the same way that their international colleagues do."

He suggested that there was a clear need for education around obesity as a disease in primary care settings, and noted that if people with obesity do not find opportunity to discuss their weight in good time, they can go on to develop all sorts of other health problems. "These are not comorbidities but complexities because obesity led to them. Waiting 9 years will make it more difficult to intervene."

Other reasons given for the delay in obtaining healthcare for their weight included that people with obesity felt that it was their own sole responsibility to manage their excess weight, and UK doctors incorrectly perceived their patients as unmotivated in their attempts at weight loss.

International Study

The study was an online survey conducted in 11 countries: Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, United Arab Emirates (UAE), and the UK. The survey found that people with obesity are motivated to lose weight but that they have little success. This is related to the biological basis of obesity, explained Prof Halford. "Sometimes a practitioner will see that they’re not losing weight once the patient has started a diet and mistakenly think they’re not that motivated."

The UK analysis of the results involved the participation of 1500 people with obesity and 306 healthcare practitioners (156 primary care physicians, and 150 secondary care clinicians) who completed the survey. Response rate for people with obesity was 14%, and for healthcare practitioners was 28%.

Dr Abd Tahrani, senior lecturer in metabolic endocrinology and obesity medicine, University of Birmingham, and honorary consultant in endocrinology at the University Hospitals Birmingham NHS Foundation Trust commented on the findings: "The results of this study should change the narrative regarding obesity and its management, which [is] desperately required to reduce the burden of this disease on patients.

"The mean duration of 9 years before seeking help for weight, which is higher than the corresponding average of 6 years globally, highlights the shortage of access to weight management services as well as the obesity stigma that makes patients blame themselves for the excess weight and the concerns regarding the reactions from the health care professionals," he added.

Obesity is a Chronic Disease: Responsibility for Weight Loss

The results showed that two-thirds of people with obesity and most healthcare practitioners (84% primary care, 89% secondary care) agreed that obesity is a chronic disease.

However, the impact of obesity on health generated mixed feelings, such that people with obesity considered their condition to have greater impact on health than did healthcare practitioners: 81% of people with obesity believed that obesity has a large impact on health that was similar to diabetes (82%), cancer (82%), and stroke (88%). However, only 68% of UK healthcare practitioners (compared with an average of 76% from all 11 countries) recognised the impact of obesity on health, and it was rated less serious than diabetes, cancer and stroke by 40%, 65% and 62% of healthcare practitioners respectively.

Dr Tahrani said that more efforts were needed in treating obesity as a chronic disease. "Despite most health care professionals considering obesity as a chronic disease, only 9% of patients were offered follow up appointments, which is not how chronic diseases are typically managed, as chronic diseases such as diabetes or hypertension require ongoing support and treatment."

Around 80% of people with obesity had made one or more serious weight loss efforts in the past, and only 18% had no plans for weight loss within the next 6 months. Only 10% of primary care professionals and 17% of secondary care professionals thought their patients were motivated to lose weight. However, 85% of people with obesity assumed full responsibility for their own weight loss; while 41% of primary care physicians and 25% of secondary care physicians placed the responsibility for weight loss on people with obesity.

"The results showed that 37% of people with obesity managed to achieve 5% body weight loss in the past 3 years, but only 28% of these managed to maintain this loss at one year," Prof Halford pointed out. "This shows how difficult it is to maintain the weight loss. We need a long-term solution."

Weight Clinics and Bariatric Services

Primary care weight management services are available but lack longevity, said Prof Halford, because they rely on year-by-year commissioning. "To build a good weight management service that responds to patient needs takes time. The current UK commissioning service doesn’t do it."

Also, National Institute for Health and Care Excellence (NICE)-approved weight loss drugs are few; specialist services are not widely available, and "bariatric surgery provision is patchy", he added.

Prof Halford also noted that primary care appointments in the UK are short and that this is detrimental to someone in need of a comprehensive exchange about their weight. "The survey found that, on the whole, patients actually accept it when healthcare practitioners bring up the subject of weight and welcome the conversation."

Obesity Care in Medical Training

Yet there is no priority given to train medical students and other healthcare practitioners in obesity and nutrition per se, said Prof Halford.

The survey found that primary care physicians are generally older than those in secondary care, and that across all countries, younger practitioners were more likely to consider obesity as a disease, discuss it with patients, and give a diagnosis. "Some of the problem might be related to age differences of the primary care physician. Also, secondary care practitioners are specialists."

Dr Tahrani also highlighted issues around education. "There’s a clear need to improve training on how to manage people with obesity by healthcare professionals, as well as educating wider society and policy makers about the pathogenesis of obesity and the benefits of weight loss, to reduce and limit the impact of obesity stigma."

The UK is joined by one other outlier in its findings around weight loss services for people with obesity. Prof Halford noted that Israel was similar to the UK in the time taken to obtain help for obesity, but no explanation for this was forthcoming at this point. 

But it was clear that internationally, if a healthcare system prioritises funding for obesity management – public or private – then outcomes for people with obesity are positive. "Reimbursement means there are targets, and investment to deal with the issue is recouped."

ECOICO 2020. Presented as a poster EP-218. 1-4 September, 2020.

COI : Professor Halford has declared no conflicts other than general ones related to the study as a whole, listed below. Dr Tahrani has declared no relevant conflicts of interest.

The study was sponsored by Novo Nordisk and all authors had travel expenses covered by Novo Nordisk to attend author meetings during the conduct of the study. One author is an employee of Novo Nordisk. Dr Carly Hughes reports consultancy for Alva outside the submitted work. 

Abstracts:

Differences in impact and perception of obesity between women and men: results from ACTION-IO.  Abstract

The underestimation of obesity by individuals needs to be addressed by healthcare professionals. Abstract

Obesity expertise: added value but still lots to do in obesity care. Abstract

Healthcare professional's age and obesity care: results from ACTION-IO. Abstract

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