- New research finds that bias about the root cause of obesity affects how healthcare professionals recommend treatment for people who are living with this chronic disease.
- Results from a survey showed that 58% of providers believe that obesity is mainly due to lifestyle choices, and 43% believe that those living with obesity can reach a healthy weight if they only “try hard enough.”
- Health experts say these biases are dangerous as they discount the fact that causes for obesity can vary widely and treatment needs to be evaluated on a case-by-case basis to ensure the best results.
When it comes to treating obesity, our growing medical understanding of the condition has shifted approaches to treatment as well as the larger cultural understanding of what it means to be living with obesity.
For the more than
Now, new data released by Eli Lilly and Company that looks at prevailing barriers that might stand in the way of normalizing and prescribing anti-obesity medications, speaks to larger issues of how many providers might discount genetics and factors that remain out of people’s control when they diagnose and treat the condition.
Often, cultural biases that often infuse our understanding of obesity can paint the condition as one that results mainly from lifestyle factors more than anything else.
How might this affect the treatment that people receive for obesity?
Healthline spoke with experts who put all of this in context and explained how issues around the treatment for obesity are nuanced and vary case by case, person by person.
The data from Eli Lilly comes from the OBSERVE study, conducted in collaboration between the pharmaceutical company, Cerner Enviza, and leading opinion leaders and researchers in the field.
It aimed to look at the factors that might illustrate where we are today in the prescription and adoption of medications to treat obesity. It also sheds a brighter light on current attitudes and provides a look at how the condition is often approached in medical settings.
Among those included in the study were people living with obesity, healthcare providers, and even employers.
The latest data from this study focused on healthcare providers’ perceptions. It was presented in May at the 2023 AACE (American Association of Clinical Endocrinologists Meeting in Seattle.
The findings revealed a striking snapshot of provider attitudes toward treating the condition.
The survey showed that 58% of surveyed providers believe that obesity is mainly due to lifestyle choices, 43% believe that those living with obesity can reach a healthy weight if they only “try hard enough,” 24% reported they believed most patients with obesity are metabolically healthy even though they are carrying extra weight, and 67% think people with obesity should be “required to demonstrate motivation to make lifestyle changes before medical treatment is offered.”
Study co-author Dr. Rekha Kumar, chief medical officer at medically-assisted weight care program, Found, and practicing endocrinologist in New York City, said the figure that shows 43% of providers believe patients with obesity can generally achieve and maintain a healthy weight if they only tried enough was particularly surprising to her.
“The science has been clear for a long time that biology plays a critical role in someone’s ability to lose and maintain weight loss, and for many people struggling with overweight and obesity, lifestyle changes are often not enough,” Kumar told Healthline. “The belief that someone can’t achieve a healthy weight, it means they are a failure or lack willpower is what continues to stigmatize patients with obesity, and prevent them from seeking and getting the medical care they deserve and need.”
When asked just how big of a challenge it is for people living with obesity to simply lose weight and then maintain that weight loss, Dr. Diana Thiara, medical director of UCSF Weight Management Clinic and UCSF assistant clinical professor, told Healthline that it’s important to note that obesity “is a chronic disease that requires long-term management.”
“It’s incredibly hard to lose weight and keep it off in the long run. We know that some people are able to sustain large amounts of weight loss for many years — things like the national weight control registry have examined this — these participants had lower rates of adverse behavior change,” said Thiara, who is unaffiliated with the study. “We need to work with our patients, continuously, for the long term, to help them achieve and maintain weight loss.”
“The other thing is that we need to accept and be okay with the fact that people with obesity will have moments of hardship and relapse throughout their lives. We should help them through these times,” she added.
In examining the fact that 58% of these respondents think obesity is due to lifestyle choices, Thiara added that this is an “overly simplistic” view of the chronic disease. She stressed that this is a complex condition, “and we don’t fully understand etiology.”
“We do know that there are certain genes that are more prevalent in individuals with obesity. The thought, however, is more that it’s a combination of having those genes plus living in an obesogenic environment — or calorie-dense/unhealthy foods in combination with sedentary lifestyles,” Thiara explained. “Additionally, there is data suggesting there is correlation between obesity and infection with certain viruses, specifically a few strains of adenovirus.”
Thiara added that our evolving understanding of the gut microbiome — at least in studies of animals — reveals that it plays a role in lean versus obese phenotypes in mice, for example.
“We are still trying to understand the role of the microbiome and weight in humans, and I hope we learn more from scientists who are actively studying this. Now, why is this a pervasive view? Obesity bias is incredibly prevalent in society, and medical providers are included here,” she said. “Studies have shown this repeatedly, and this includes all types of providers — from nurses to doctors. Obesity bias is a big problem in the medical field. I think this bias makes us ‘blame’ patients for having excess weight.”
Pushing against some of these entrenched views of obesity can be hard.
Kumar said the idea that lifestyle choices above all else are the main factor affecting obesity obscures the very nuanced reality of all of the factors and moving parts that are coming into play with this health issue.
It fails to take into account that the presence of this disease varies widely between individuals.
For some people, lifestyle changes may very well be effective at both losing weight and then maintaining a healthy weight. Seeing this work in some people can sometimes paint a very incomplete picture that providers then take as the “norm.”
“The truth is that weight loss is only successful long term for a very select amount of people and does not accurately reflect what most people experience — a daily struggle to lose weight or keep it off after losing it,” Kumar said. “As providers, we have been trained to focus on chronic diseases like high blood pressure, diabetes, heart disease. Being overweight or obese is still being viewed as [a] lifestyle/wellness issue, even though the American Medical Association
This means data like this can result in a call to action of sorts.
“It’s time we start treating obesity like every other chronic disease. That starts with acknowledging that there are biological factors working against most people on their journey to lose weight, and until those biological factors are addressed, long-term weight loss is not likely to be successful,” Kumar added.
Obesity advocacy groups think a lot about ways to fight against these biases.
The Obestiy Action Coalition (OAC) is a nonprofit that offers a voice and platform to Americans nationwide who are affected by the condition.
Former OAC board member Ted Kyle, RPh, MBA, founded ConscienHealth in 2009 in order to assist organizations and experts to move toward evidence-based approaches to obesity and achieving overall health.
Kyle, who is unaffiliated with the OBSERVE study, told Healthline that the scientific understanding of obesity has changed a great deal over the past decade.
“For people who devote their careers to the study and clinical care for obesity, this new knowledge is no big deal. But for average clinicians, it’s mind-boggling because they did not learn about this in medical school,” he said.
In pushing against those medical biases that suggest all one needs to do is just exercise more or adopt a new diet of some kind and it will be very easy to do so, Kyle said this is a perspective that is “mostly false.”
“Obesity is the result of genetic susceptibility triggered by a wide range of environmental factors — the food supply, barriers to physical activity, stressors, and drugs and chemicals that cause weight gain. Lifestyle choices can help a person cope, but they are not the most common trigger for this disease,” Kyle said. “The narrative is entrenched because most providers get their understanding of obesity from false narratives prevalent in popular culture, rather than from medical education by people who understand this disease.”
For her part, Thiara said that obesity bias can create a negative domino effect that feeds a lack of understanding of the disease, a lack of interest in learning how to treat it, and not enough focus on obesity in medical education.
In medical training, why might obesity be overlooked?
“First, there is the prevalence of bias that tells people they should be able to overcome obesity through sheer force of will. Second, there is the longstanding lack of effective options for treatment other than metabolic and bariatric surgery. Third is the exclusion of coverage for science-based obesity care by most health plans,” Kyle said.
When asked what treatments she would prescribe to a person who comes to her who has obesity, Thiara said lifestyle change is certainly foundational to work with weight management. This is because “patients need to also be working on lifestyle changes so they are able to maintain weight loss in the long run.”
“Beyond lifestyle change, more intensive options like medications or surgery really depend on the individual’s comorbidities and health status, their overall goals, and their personal preferences,” Thiara added. “We know that medications for weight loss and surgical options will achieve, on average, more weight loss than lifestyle intervention. However, they also have side effects. We need to have conversations with our patients to decide together what are the best steps for patients.”
She also said that if you have obesity and are looking for health care that makes the most sense for you, the first step is to possibly find a team — a primary care provider, yes, but also potentially a nutritionist or a behavioralist.
“For some patients, this is an adequate combination. In an ideal world, patients with obesity would be referred to specialty weight management programs and get comprehensive inter-professional care and/or bariatric surgery programs — depending on a patient’s interest in procedural intervention,” Thiara said.
Kumar said that whether you should be focusing on lifestyle modifications, new medications, surgery, or other forms of treatment, it all depends on what a provider who specializes in obesity determines makes the most sense for you. There is no one-size-fits-all approach.
“It’s also important to note that while ‘medispas’ and certain physicians may liberally prescribe medications like Ozempic these days to people who don’t meet the criteria for it. That’s not only irresponsible, but it also may not be the safest, most effective option. That’s something you should keep in mind before requesting it from your doctor,” Kumar stressed.
She pointed to Found, where she serves as chief medical officer. This is a weight management program that combines biology and behavioral change as an example of an integrated, personalized approach.
What if you are seeking care, but come in contact with a provider who exhibits some of the aforementioned toxic views on obesity the study highlighted?
Kyle said it can be a challenge to find a provider who is well-versed in obesity and the kind of treatment that might be right for you.
“Yes this can be a challenge,” he said. “The best bet is to look for a provider who is board-certified in obesity medicine.”
He pointed to the American Board of Obesity Medicine as one option here.
Kumar said if you come across a provider who is giving “outdated guidance for weight loss,” you should seek another who specializes in treating obesity as a chronic disease.
As with seeking care for any chronic condition, do your research, and look for a provider who specializes in a field that best applies to you.