At the inaugural OPEN meeting in Nashville in 2018, the consensus across the attending national delegations was that the network should explore and address the following four critical areas of focus:
Recognizing obesity as a disease:
Obtain governmental, clinical and public recognition of obesity as a disease to ensure responsibility moves from individual to shared.
Myths and misconceptions of obesity are prevalent in the media, popular culture and scientific literature, representing people with obesity as lazy, unhealthy and unmotivated individuals.1,2,3 At the root of the problem is the belief that obesity is a lifestyle choice which is due to poor self-discipline and lack of motivation.
The presence of stigma can result in poorly-informed clinical decisions, inaccurate public health recommendations and unproductive allocation of limited resources.4 For individuals with obesity, stigmatisation is associated with greater psychological distress and more severe obesity.5 Not treating obesity like any other chronic disease requiring holistic interventions – which combine lifestyle modifications with behavioural therapy, pharmacotherapy and, in certain cases surgery – translates into a vicious cycle of inaction and increases risk of obesity-related complications in people with obesity.6,7
Secure funding for training:
Review and optimize allocation of healthcare resources to secure funding for care
Obesity is not a new problem and vast resources are being spent on obesity-related complications and disorders.8 Current clinical pathways do not enable healthcare practitioners to effectively diagnose, monitor and treat obesity, leading to insufficient funding and clinical guidance.9,10
A 5-10% weight loss can reduce the severity or risk of complications and result in improvements in physical function, self-esteem and health related quality of life, as well as reduce costs to the healthcare system and society as a whole.11,12,13 Reviewing and reprioritising current funding and care pathways to focus on obesity as a condition/medical specialty has the potential for great savings as it will enable the treatment of obesity and the prevention of obesity-related complications.
Obesity in learning curricula:
Integrate obesity to learning curricula across obesity-related professions to support more effective, informed care
Weight bias amongst health care practitioners (HCPs) is impairing the care of people with obesity.14,15 The current lack of understanding of obesity has resulted in several barriers to effective clinical management, including a poor knowledge among health care professionals (HCPs),16,17 poor patient-HCP communication,18,19 limited availability and adoption of treatment options,9,20,21 and insufficient reimbursement for obesity management.21
Lack of education and guidance leave most HCPs ill-equipped to effectively communicate with patients and provide appropriate diagnosis and treatment. People with obesity who report not receiving a formal diagnosis and provision of external support have a lower chance of achieving weight loss success.22,23 Without continuous support, people with obesity experience decreased motivation and lack of confidence, which negatively affects their weight loss success and overall health 12,22
Multidisciplinary obesity centres:
Establish multidisciplinary obesity centres and ensure access to transdisciplinary care for people with obesity
Obesity is a complex multifactorial chronic disease which is influenced by genetic, physiological, environmental psychological and socioeconomic factors.24,25,26,27 Obesity is associated with around 200 disorders including type 2 diabetes, cardiovascular diseases and certain types of cancer.28
Due to obesity being a risk factor for many other disorders, acknowledging and treating obesity as the primary disease provides an opportunity to tackle the many associated complications and minimises the pressures on healthcare systems and patients.
Acknowledging obesity as a disease would help to facilitate clinical pathways that would enable general physicians to take a more active role in managing people with obesity. In turn, this would reduce pressures on specialist services.
1Heuer, C. et al. 2011. Obesity stigma in online news: a visual content analysis. Journal of Health Communication; 16 (9): 976-987
2McClure, K.J. et al. 2011. Obesity in the news: do photographic images of obese persons influence antifat attitudes? Journal of Health Communications; 16 (4): 359-71
3Chaput, J.P. et al. 2014. Widespread misconceptions about obesity. Can Fam Physician; 60; 973-975
4Casazza K. et al. 2013. Myths, presumptions, and facts about obesity. N Engl J Med; 368(5):446–54
5Myers, A., Rosen, J.C. 1999 Obesity stigmatization and coping: relation to mental health symptoms, body image, and self-esteem. International Journal of Obesity; 23: 221–230
6 Frood, S. et al. 2013. Obesity, complexity, and the role of the health system. Curr Obes Rep 2; 320–326
7Puhl, R., Heuer, C. 2010. Obesity stigma: important considerations for public health. American Journal of Public Health; 100 (6):1019-102
8McKinsey Global Institute. 2014. Overcoming obesity: an initial economic analysis. [Online] Available at: https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/Economic%20Studies%20TEMP/Our%20Insights/How%20the%20world%20could%20better%20 fight%20obesity/MGI_Overcoming_obesity_Full_report.ashx [Accessed October 2018]
9Thomas, E.C. et al, 2016. Low Utilization of Obesity Medications: What are the Implications for Clinical Care?. Obesity; 24(9):
10 European Association for the Study of Obesity. 2018. Survey of European GPs – GPs’ perceptions, knowledge and treatment of obesity [Online] Available at: https://www.europeanobesityday.eu/gpsurvey/ [Accessed October 2018]
11 Dall, T.M. et al. 2011. Weight loss and lifetime medical expenditures: a case study with TRICARE prime beneficiaries. Am J Prev Med; 40(3): 338-44.
12 Vasiljevic, N. et al. 2012. The relationship between weight loss and health-related quality of life in a Serbian population. Eur Eat Disord Rev; 20(2):162-8.
13 Kolotkin, R.L. et al. 2009. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes; 7:53
14 Henderson, E. 2015. Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities. Br J Gen Pract; 65 (633): e240-e247
15 Lewis, S. et al. 2010. Do health beliefs and behaviors differ according to severity of obesity? A qualitative study of Australian adults. Int. J. Environ. Res. Public Health; 7: 443-459
16 Stanford, F.C. et al. 2015. The role of obesity training in medical school and residency on bariatric surgery knowledge in Primary Care physicians, International Journal of Family Medicine; 841249
17 Phelan, S. et al. 2014. Implicit and explicit weight bias in a national sample of 4,732 medical students: The medical student CHANGES study, Obesity; 22: 1201–8
18 Ma, J. et al. 2009. Adult obesity and office-based quality of care in the U.S. Obesity (Silver Spring); 17:1077–85
19 Blackburn, M. et al. 2015. Raising the topic of weight in general practice: perspectives of GPs and primary care nurses, BMJ Open; 5:e008546
20 Haslam, D. 2016. Weight management in obesity – past and present, International Journal of Clinical Practice; 70: 206–17
21 Toplak, H. et al. 2014. EASO Position Statement on the Use of Anti-Obesity Drugs. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644876/ (Accessed October 2018)
22 Visram, S. et al. 2009. Triggers for weight gain and loss among participants in a primary care-based intervention. Br J Community Nurs; 14(11): 495-501
23 Kaplan, L.M. et al. 2017. Divergence in perceptions and attitudes among people with obesity, healthcare professionals, and employers create barriers to
effective obesity management: results of the national ACTION study. ECO 2017 encore, ACTION Quant employers abstract
24 Guyenet, S.J., Schwartz, M.W. 2012 Regulation of food intake, energy balance, and body fat mass: implications for the pathogenesis and treatment of
obesity. J Clin Endocrinol Metab; 97:745–55
25 Badman, M.K., Flier, S.J. 2015 The gut and energy balance: visceral allies in the obesity wars. Science; 307: 1909–14
26 Tanaka, T. et al. 2013. Genome-wide meta-analysis of observational studies shows common genetic variants associated with macronutrient intake. Am J Clin
Nutr; 97: 1395–402
27 Woods, S.C., Seeley, R.J. 2002. Understanding the physiology of obesity: review of recent developments in obesity research. Int J Obes Relat Metab Disord;
28Yuen, M.M. et al. (n.d.). A systematic review and evaluation of current evidence reveals 236 obesity-associated disorders. Massachusetts General Hospital
& George Washington University. [Poster presentation]