In a previous blog, we noted the importance of increasing awareness of obesity as a health crisis, not to mention the Herculean effort required to initiate change on the scale needed to make a difference. Adding to the challenge of this undertaking is the fact that more people than ever before are overweight or obese, yet fewer people consider themselves members of these categories. Thus, for change to occur, people must first recognize their weight as being too high, and then understand and accept the changes that must be made to achieve and maintain a truly healthy weight.
We know that the population as a whole is turning a blind eye towards their own increased obesity, but of greater concern is the inability or unwillingness of the medical community to recognize overweight or obesity among patients. There is strong evidence that too many physicians are reluctant to diagnose and document cases of obesity. For example, a 2018 study found that only 52 percent of primary care providers across different fields could assess BMI correctly and that they were more likely to underestimate, rather than overestimate it. There was also a big gap between those who reported simply calculating BMI (91 percent) as compared to those who actually discussed the impact of a high BMI with patients (61 percent).
This is problem on several levels. First, a lack off diagnosis could affect patients’ perception of the seriousness of their health situation. Although physicians will recommend exercise and dietary counseling, without a formal diagnosis, patients may view exercise and diet advice as just that — some friendly advice. Also, as noted, when other obesity-related diseases are diagnosed and treated with only a cursory connection to obesity, the other disease becomes the focus by necessity. Earlier intervention in addressing the causes — including obesity — potentially could eliminate the need to treat the other diseases. This preventive measure also would impact health and financial costs.
Further, there is evidence connecting an obesity diagnosis and weight loss. A study published in Obesity found a link between patients who had an obesity diagnosis and a weight loss of at least five percent. The authors suggest the diagnosis can be instrumental in engaging patients to lose weight.
Clearly there are benefits to making a formal diagnosis. So why aren’t physicians doing it? There are a few contributing factors. On a practical level, the way obesity is classified by Centers for Medicare & Medicaid Services remains an issue of debate, as does a consistent definition. On a more personal level, physicians with obesity are less likely to document obesity in their patients. There is also research that finds some physicians place a heavy emphasis on lifestyle as a primary contributor to obesity, rather than acknowledging the influence of biological factors, suggesting a lack of understanding of the disease and its psychological impact. Then there are those at the other end of the spectrum who are quick to blame a wide range of injuries or illness on obesity, sometimes without even examining a patient. In addition to potentially overlooking a serious condition, this contributes to the stigma associated with being overweight or obese and can deter patients from seeking medical help.
Awareness will succeed only if it is supported by early intervention, which is critical to long-term changes in the rate of obesity. This needs to begin now, and as with other major diseases, must start with a diagnosis.