Without access to trained providers, most people who suffer from Obesity won’t reach and maintain a healthy long-term weight goal.
In almost all high income countries, people who suffer from the chronic disease of obesity must be provided with affordable and reimbursable access to specialized healthcare providers who can treat the disease with individualized treatment approaches of diet, anti-obesity medication, behavior and exercise options that are unique to the individual; in some cases that may also include surgical intervention.
Care provided by a properly trained clinician who either specializes in Obesity Medicine or has extensive training in the use of anti-obesity medication and treatment plan options, is still not readily available in most areas. Obesity is a complex, chronic disease with many contributing factors that challenge primary care and obesity medicine specialists alike, but without access to properly trained specialty providers, most people who suffer from Obesity will not be able to reach and maintain a healthy long-term weight goal.
Access to healthcare in itself can be challenging based on geographic clinician shortages, transportation barriers, insurance coverage and the lack of trained obesity medicine specialists, especially since most Medical School programs do not offer specialized Obesity care curriculum yet.
The general lack of awareness that obesity is indeed a disease within the medical community at large, and the public’s belief that obesity is the result of a lifestyle choice and not a disease, creates an additional barrier to treatment. This is especially the case in low- and middle-income countries, where health systems are especially poorly equipped to manage the challenge. A recent study of obesity in health systems in more than 60 countries found that most lack adequate services to tackle obesity. The main reasons mentioned for lack of treatment were lack of care pathways from family physician to secondary services; insufficient secondary, multi-disciplinary services and trained professionals; high costs to patients; the prevailing obesogenic environment; and stigma experienced by patients within the health care services. In many countries, merely entering the health system – and remaining in it – are cited as being among the biggest hurdles faced by patients living with obesity. Respondents in 47% of the countries stated that there were difficulties obtaining referrals for obesity treatment, while a lack of treatment options and clear pathways to treatment were mentioned as problems, especially in lower-income countries.
Respondents in 37 countries (54%) stated that the main funding for treatment would be provided by the patient (‘out-of-pocket’ payments) while in only four countries (6%) re-spondents stated that government funding or insurance funding was the main means for paying for treatment. This is exacerbated by the lack of training for health care profes-sionals in obesity diagnosis, management and treatment. Specific skills that are currently missing in most healthcare systems are: proper obesity diagnosis, recognising endocrine or orthopaedic problems, providing bariatric surgical skills, providing expert advice in pregnancy, providing appropriate advice on nutrition and physical activity, and providing psychological and behavioural support. Furthermore, these skills should be part of the necessary training of a multidisciplinary team to support treatment and follow-up, which is missing in an overwhelming majority of healthcare systems.
When it comes to the complex treatment of obesity, we must focus on disease awareness, specialty clinician availability, early diagnosis and access to specialty care for all life stages from pediatric patients to senior adults. Long term access to specialized obesity medicine care is key to the success in treating obesity.