A survey of adults living with obesity and their physicians across seven countries reveals a high disconnect between their perceptions about the causes of obesity and treatment goals. The findings being presented at this year’s European Congress on Obesity (ECO) in Malaga, Spain (11-14 May), highlight biased misconceptions about obesity which may impact patients’ access to treatment and support.

“Although the causes of weight gain and obesity are diverse and complex-and often beyond an individual’s control-many people still hold biased beliefs that frame obesity as a result of personal choices, such as healthy eating and exercise alone. These misconceptions simplify obesity into a matter of personal willpower, placing full responsibility on the individual and often leading to stigma, rather than encouraging compassionate, evidence-based chronic disease care,” said lead author Dr Ximena Ramos Salas from K&X Ramos AB, a research and consulting agency in Sweden

Although classified as a chronic, relapsing disease, obesity is often not adequately managed or prioritised in healthcare settings. Understanding of the disease among physicians and people with obesity is limited, partly due to deep-rooted weight bias and stigma. As a result, people with obesity lack access to evidence-based and person-centred care.

To understand more about physicians’ and patients’ beliefs about the causes of obesity and therapeutic goals, Dr Ramos Salas and co-authors from Eli Lilly and Company, Adelphi Real World and University of Rome Tor Vergata analysed data from the Adelphi Real World Obesity Disease Specific Programme™-a linked physician and patient cross-sectional survey with retrospective data collection which was conducted in France, Germany, Italy, Spain, the UK, the USA and Australia between October 2023 and April 2024.

Physicians provided data and answered survey questions based on the first eight consultations during the study period with adult patients (aged 18 or older) living with obesity who had a current/prior body mass index (BMI) of 30 kg/m² or higher, or a current/prior BMI of 27 kg/m² or higher, and at least one obesity-related complication. The physician survey included questions on what, in their opinion, were the main reasons for each patient’s obesity and what their treatment goals were for the patient.

Their patients with obesity were then asked to complete a voluntary questionnaire which included questions asking about their perceptions of obesity causes and therapeutic goals. The patient survey included questions on what, in their opinion, were the reasons for their current weight problems and what they were hoping for when they lost weight.

In total, 1,379 responses from patients with obesity and their physicians were analysed by body mass index (BMI) category and the Edmonton Obesity Staging System (EOSS) classification-which classifies obesity on a five-point scale according to severity and underlying health conditions.

Biased misconceptions about obesity

The results showed that physicians tended to report behavioural causes for their patients’ obesity-most commonly overeating (69%), followed by lack of exercise (61%), high fat diet (51%), and lack of motivation (49%; see figure 1 in notes to editors).

Notably, physicians were more likely to cite behavioral causes as their patients’ BMI and EOSS category increased. For example, three-quarters of physicians said that the primary cause of obesity in their patients with class III obesity was overeating, while two-thirds cited lack of exercise.
As Dr Ramos Salas explained, “Individuals tend to have more negative attitudes towards people with obesity if they believe that obesity is mostly a behavioural issue.”

Although the majority of people with obesity attributed their obesity to behavioural and socioeconomic causes (87%), they did so to a lesser extent than physicians (98%), reporting much higher levels of biological causes than physicians (81% vs 61%).

People with obesity also regarded genetics as third leading overall cause of their obesity, while physicians ranked genetics as 7th on the list of all causes (see figure in notes to editors).

Differing treatment goals

When asked about treatment goals for their patients with obesity, physicians tended to report health-focused outcomes-most commonly, improving quality of life (around 75%), increasing mobility (roughly 50%), and lowering blood pressure (around 45%), regardless of BMI or EOSS status (see figure 3 in notes top editors).

In contrast, when people with obesity were asked what they were hoping for when they lost weight, they tended to focus on how they would look and feel, regardless of weight loss outcomes. For example, around two-thirds reported hoping to look or feel better, to feel more confident, and be able to fit into smaller clothes sizes, objectives which reflect more psychosocial outcomes, rather than just physical health improvements.

According to Dr Ramos Salas, “Physicians play a key role in shaping treatment decisions and can offer supportive, compassionate care to patients living with obesity by focusing on improvements in overall health and psychosocial well-being, rather than just weight loss. By recognising and addressing internalised weight stigma, doctors can also help patients access additional resources that promote body acceptance, reduce self-blame, and build confidence.”