Most With Obesity Don't Get a Diagnosis or Referral for Care, Study Finds

Nearly three-fourths of people who have obesity talk to a doctor about it, but only about half get a formal diagnosis and one-fourth receive no follow-up care, according to the most recent results of a long-term study presented at Obesity Week and published in the journal Obesity.

Results from the ACTION study, which involved more than 3000 patients and interviews with 600 healthcare professionals and 150 employers, revealed the barriers that people with obesity face when trying to get care. Data reported at Obesity Week, being held in National Harbor, Maryland, were gathered from October 29, 2015, to November 12, 2015. They show:

• People with obesity try several times to lose weight, but only a few are able to achieve weight loss and sustain it. Only 23% of those with obesity reported 10% weight loss during the previous 3 years.
• While obesity is now recognized as a disease—the American Medical Association declared it so in 2013—most people with obesity still think it’s their own responsibility, which may stop them from seeking medical help.
• Of the 71% of those with obesity who seek doctor’s help, only 55% get a formal diagnosis of obesity.
• Employer wellness programs fall short for people with obesity even though the disease contributes to some of the top cost drivers in health plans, such as diabetes and cancer.
• Only 24% of those with obesity get follow-up care after an initial appointment.

The findings stand in contrast to official US health policy on obesity care. In 2012, the US Preventive Services Task Force recommended that all adults be screened for obesity and those with a body mass index (BMI) of 30 kg/m² or higher be offered a referral for “intensive, multicomponent behavioral interventions,” with a B recommendation. Under the Affordable Care Act, this should be covered by payers. But the study found that healthcare professionals recommended “counseling or lifestyle modification” to only 32% of patients with obesity. Fewer still (11%) were offered prescription weight loss medication, and 7% were offered surgery.

Not Enough Time for Obesity

The physicians who took part in the study included both primary care physicians (PCPs) and obesity specialists, with PCPs outnumbering the specialists by a 5:1 ratio. Physicians most often cited lack of time during the appointment (52%) as the reason they didn’t start a discussion about weight loss, followed by “more important issues and concerns,” (45%). This happened even though more than 50% of the physicians believed obesity was as serious as related health problems like diabetes, high blood pressure, diabetes, or congestive heart failure—and that patients with obesity would not live as long as those of normal weight. Two-thirds of doctors said they started conversations about weight loss, while the other one-third said patients brought it up. Two-thirds said they were comfortable talking to patients about their weight.

Todd Hobbs, MD, who is Novo Nordisk's chief medical officer for diabetes, North America, said he recalls the time pressures of primary care practice, but the challenges patients face were still worse than expected. "Patients continue to face stigma, and there's frustration that they don't know how to don't know how to discuss obesity with their physician ... We really want to call out some of these barriers."

Employers Concerned, but Not Responsible

Wellness programs are becoming more common, and employers are motivated almost equally by the desire to reduce insurance premiums (75%) and to promote health among their staff (72%). Yet they are split on covering obesity management, with 52% endorsing putting it in insurance coverage. Cost of medical claims, potential effect on premiums, and lack of data on return on investment were cited as reasons.

When asked who is responsible for weight loss, 82% of those with obesity said it was completely their own responsibility; 72% of the healthcare professionals said they have responsibility to contribute to patients’ weight loss. Among employers, 46% disagreed with the statement that they are partially responsible for employee weight loss. While nearly two-thirds of healthcare professionals (64%) and three-fourths (72%) of employers think employer wellness programs help with weight loss, only 17% of those with obesity agreed. But all 3 groups agreed that lack of exercise was the biggest barrier to weight loss.

“We in the healthcare community must ask why this epidemic is not being diagnosed and treated with the same urgency and focus as any other serious disease,” Lee Kaplan, MD, director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital and lead author of the study, said in a statement. “We need to fundamentally rethink obesity so that the public and healthcare community understand more about the biology, chronicity, and overall health impact of this disease.”

Hobbs said payer coverage for Saxenda (liraglutide), Novo Nordisk's FDA-approved obesity therapy, is slowly improving. However, he said employers are slower than health plans to grasp the science, and there's work to be done to get them to see the connection between paying for obesity treatment and increased productivity.

ACTION, which stands for “Awareness, Care and Treatment In Obesity Management,” is the first US-based study to examine barriers to obesity treatment from the perspective of people living with the disease. Sponsored by Novo Nordisk, the study has a steering committee that includes representatives from patient advocacy groups, primary care, endocrinologists, psychology, and nursing.

Reference

Kaplan LM, Golden A, Jinnett K, et al. Perceptions of barriers to effective obesity care: results from the ACTION study [published online October 31, 2017]. Obesity. 2017; DOI: 10.1002/oby.22054.