Two-thirds of people living with obesity blamed themselves, and 82% who had seen or spoken to a doctor about their weight received lifestyle-focused recommendations, reinforcing the outdated narrative that obesity is a matter of discipline, a new survey revealed.

The 14-country survey of 14,500 adults found 63% of people living with obesity agreed that "diet and exercise alone can solve obesity for most people." This suggested that the majority of respondents still felt personally responsible for both the condition and the solution — despite the fact that 71% also believed that obesity is "a medical condition requiring ongoing management." These contradictory findings demonstrated a disconnect between the intellectual understanding of obesity and internalized belief, according to the survey authors.

Self-blame and misunderstanding of obesity as a disease are likely contributing to a reluctance to seek medical help. The survey found that more than eight in 10 respondents (81%) had tried or been advised to lose weight, but only about one in three (35%) had consulted a doctor about their weight in the past year. 

The survey, conducted by market research firm Ipsos, was published online on World Obesity Day, March 4.

'Substantial Burden' on Everyday Life

Overall, those living with obesity were 19 percentage points less satisfied with their physical health than those not living with obesity, with 48% worried about future health problems and 42% anxious about their current health or well-being. 

Yet, despite the worry about their health, knowledge about the risks of obesity was low: Only half of respondents were aware of the links to heart disease (52%) and diabetes (53%), and even fewer linked obesity with certain cancers (18%).

Perceived judgment from others compounds the "substantial burden" of obesity in everyday life, with 36% of survey respondents saying they are anxious about how others see them. People living with obesity were more likely than those not living with obesity to frequently feel judged based on how they look (35% vs 24%), be self-conscious or embarrassed (35% vs 24%), and feel perceived as lacking self-control or willpower (32% vs 21%). 

The majority (70%) of respondents have avoided social, leisure, or romantic activities in the past year due to their weight — a finding that was amplified among women, younger adults, and employed individuals.

Clinicians Perpetuate 'Old Messages' 

People living with obesity who sought medical advice reported receiving recommendations that often reinforced the "personal failure" narrative. These included "eat healthier" (60%); "do more exercise or physical activity" (60%); "eat smaller portions" (43%); "take vitamins, supplements or other products that do not require a prescription"; and "join a weight management program or use a digital health tool."

Only 25% were advised to take a prescription medication to reduce weight, and 22% were advised to take a prescription medication to manage preexisting conditions.

"While we now understand much more about the deep complexity of obesity's etiology and maintenance, including genetics and social drivers of health, that knowledge has not replaced old ways of thinking," Amy R. Beck, PhD, a licensed clinical health psychologist at Health Psychology Partners in Washington, DC, told Medscape Medical News.

"Old messages are perpetuated by well-meaning family members, undertrained healthcare providers and systems, and the billion-dollar weight-loss industry that profits from people feeling poorly about themselves," said Beck, who was not involved in the survey.

Research has shown that internalized weight bias has "broad, sweeping negative impacts on health outcomes and quality of life," she noted. "I see it frequently show up in a number of different ways for patients, such as feeling like they don't deserve to regularly eat food, isolation from others, and depression/anxiety." 

Unsurprisingly, as the survey showed, many are hesitant to seek help, particularly in traditional healthcare settings, due to negative experiences. "Coupled with the prevalence of outdated and unhelpful treatment recommendations in these same systems, it becomes a risk-versus-reward calculus that often reinforces disengagement from them," Beck said.

Clinicians need to be aware of the latest information on obesity; take stock of their own beliefs, attitudes, and biases about obesity and individuals who have it; be aware of the negative experiences that are common among individuals with obesity; "and commit to not being part of them," she added. 

"There is plenty of education available on the science of obesity, how to safely communicate with individuals who have it in a trauma-informed way, and the environmental accommodations that are needed in a healthcare practice to safely care for individuals living in larger bodies," she concluded. 

The survey was funded by Eli Lilly. Beck reported no relevant conflicts of interest.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.