Abstract
Introduction
In patients with obesity (PwO) and heath care providers (HcPs), there appears to exist a discrepancy between recognition of obesity as a disease and the underlying biology of the disease. This is evident when considering PwO and HcPs appear to agree obesity is a disease but position lifestyle related factors as the main barriers to treatment with “eat less and move more” considered the best treatment approach. This does not align with current evidence regarding obesity treatments and the underlying pathophysiology. An understanding of PwO beliefs and perceptions may facilitate improved communication strategies with regard to the underlying pathophysiology of obesity as a disease. This has the potential to lead to improvements in both prevention and treatment strategies. Therefore, we evaluated PwO beliefs and perceptions of obesity as a disease, obesity causation and obesity treatment recorded during clinical evaluation.
Methods
As part of usual clinical practice we record 9 items to investigate beliefs and perceptions of obesity in PwO. We used a clinical audit to determine how frequently this information was formally recorded and to explore the association between beliefs and perceptions.
Results
The information was formally recorded in the patients’ chart in 52 out of 108 patients (49%) who were part of an intensive lifestyle and medication program between 2018 and 2020. We found PwO tend to agree that obesity is a disease and that weight loss maintenance is dependent on willpower. A strong tendency towards agreement was present for the statement exercise is essential for weight loss. For the statement exercise is as effective as diet alone for weight loss, a tendency towards disagreement was present. Seventy-nine percent of PwO claimed to know the recommended guidelines for exercise with average response aligning with the America College of Sports Medicine recommendations. In exploring the relationship between responses, a number of significant associations were present which may facilitate future approaches to changing the narrative around obesity as a disease and isolating specific aspects of the message that need to be focused upon for the PwO.
Conclusion
PwO appear to have conflicting beliefs regarding obesity as a disease and the underlying biology. This has the potential to hinder attempts to treat the disease via lifestyle intervention and may also reduce likelihood to consider alternative treatment options. These beliefs and perceptions need to be explored further, along with those of HcPs, policy makers and the general public. Collectively this may facilitate changing the narrative around obesity as a disease and positively impact both the prevention and treatment of this disease.
Similar content being viewed by others
References
Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B(57):289–300
Caterson ID, Alfadda AA, Auerbach P, Coutinho W, Cuevas A, Dicker D, Hughes C, Iwabu M, Kang JH, Nawar R, Reynoso R (2019) Gaps to bridge: misalignment between perception, reality and actions in obesity. Diabetes Obes Metab 21(8):1914–1924
Dulloo AG, Jacquet J, Miles-Chan JL, Schutz Y (2017) Passive and active roles of fat-free mass in the control of energy intake and body composition regulation. Eur J Clin Nutr 71(3):353–357
Foster-Schubert KE, Alfano CM, Duggan CR, Xiao L, Campbell KL, Kong A, Bain CE, Wang CY, Blackburn GL, McTiernan A (2012) Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity 20(8):1628–1638
Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD (2016) Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity 24(8):1612–1619
Gadde KM, Martin CK, Berthoud HR, Heymsfield SB (2018) Obesity: pathophysiology and management. J Am Coll Cardiol 71(1):69–84
Gaesser GA, Angadi SS, Sawyer BJ (2011) Exercise and diet, independent of weight loss, improve cardiometabolic risk profile in overweight and obese individuals. Phys Sportsmed 39(2):87–97
Garber, C.E., Blissmer, B., Deschenes, M.R., Franklin, B.A., Lamonte, M.J., Lee, I.M., Nieman, D.C. and Swain, D.P., 2011. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise
Grannell A, Al-Najim W, Mangan A, Kapoor N, Martin WP, Murphy JC, Docherty NG, le Roux CW, Davenport C (2019) Fat free mass is positively associated with hunger and energy intake at extremes of obesity. Appetite 143:104444
Heymsfield SB, Wadden TA (2017) Mechanisms, pathophysiology, and management of obesity. N Engl J Med 376(3):254–266
Kaplan LM, Golden A, Jinnett K, Kolotkin RL, Kyle TK, Look M, Nadglowski J, O'Neil PM, Parry T, Tomaszewski KJ, Stevenin B (2018) Perceptions of barriers to effective obesity care: results from the national ACTION study. Obesity 26(1):61–69
Paixão C, Dias CM, Jorge R, Carraça EV, Yannakoulia M, de Zwaan M, Soini S, Hill JO, Teixeira PJ, Santos I (2020) Successful weight loss maintenance: a systematic review of weight control registries. Obes Rev 21:e13003
Puhl RM, Heuer CA (2010) Obesity stigma: important considerations for public health. Am J Public Health 100(6):1019–1028
Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL (2008) Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr 88(4):906–912
Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360(9):859–873
Saxon DR, Iwamoto SJ, Mettenbrink CJ, McCormick E, Arterburn D, Daley MF, Oshiro CE, Koebnick C, Horberg M, Young DR, Bessesen DH (2019) Antiobesity medication use in 2.2 million adults across eight large health care organizations: 2009-2015. Obesity 27(12):1975–1981
Sharma AM, Bélanger A, Carson V, Krah J, Langlois MF, Lawlor D, Lepage S, Liu A, Macklin DA, MacKay N, Pakseresht A (2019) Perceptions of barriers to effective obesity management in Canada: results from the ACTION study. Clin Obesity 9(5):e12329
Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J (2011) Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 365(17):1597–1604
Thorogood A, Mottillo S, Shimony A, Filion KB, Joseph L, Genest J, Pilote L, Poirier P, Schiffrin EL, Eisenberg MJ (2011) Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials. Am J Med 124(8):747–755
Trainer S, Brewis A, Wutich A (2017) Not ‘taking the easy way out’: reframing bariatric surgery from low-effort weight loss to hard work. Anthropol Med 24(1):96–110
Tremmel M, Gerdtham UG, Nilsson PM, Saha S (2017) Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health 14(4):435
Wadden TA, West DS, Neiberg RH, Wing RR, Ryan DH, Johnson KC, Foreyt JP, Hill JO, Trence DL, Vitolins MZ, Look AHEAD Research Group (2009) One-year weight losses in the Look AHEAD study: factors associated with success. Obesity 17(4):713–722
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 1550 kb)
Rights and permissions
About this article
Cite this article
Grannell, A., Fallon, F., Pournaras, D. et al. Exploring patient beliefs and perceptions regarding obesity as a disease, obesity causation and treatment. Ir J Med Sci 190, 163–168 (2021). https://doi.org/10.1007/s11845-020-02319-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-020-02319-y