Survey reveals surprising mismatch between perception and reality of obesity in America

In a new survey, half of those with obesity failed to recognize themselves as obese, and 28% of doctors didn't think it was their job to help obese patients lose weight.
(Peter Dazeley / Getty Images)

Nearly 40% of American adults and 20% of children carry enough extra weight to warrant a diagnosis of obesity. That’s the highest obesity rate among the world’s affluent nations, and it’s already shortening Americans’ lifespans by driving up rates of diabetes, heart disease, stroke, cancers, arthritis and dementia.

If that constitutes an urgent threat to the nation’s health, you’d scarcely know it from reading the results of a newly published survey called ACTION.

The new poll paints a picture of obese adults who are clueless and feel utterly on their own when it comes to losing weight and of physicians who are often too busy, too embarrassed or too ill-equipped to help them.


The nation’s obesity crisis has been roughly four decades in the making. The ACTION report is a humbling reminder that, at this rate, it will not be quickly reversed.

ACTION stands for Awareness, Care and Treatment in Obesity Management. During two weeks in the fall of 2015, survey-takers assessed how obesity was viewed, experienced and treated by 3,008 obese adults and 606 doctors who provide medical care to such patients.

What they found is a medical establishment still navigating its role in addressing obesity, and a population of patients not yet sure they need — or have a right to demand — help in shedding extra pounds. The results were presented at this week’s meeting of the Obesity Society and published in the journal Obesity.

The American Medical Assn. formally recognized obesity as a “disease” in June 2013. That medical consensus has not fully penetrated the ranks of doctors: Only 80% stated they believe obesity is a disease, and only 72% said they have a responsibility to actively contribute to their patients’ weight loss.

Awareness among patients with obesity was even worse. Some 65% of obese patients said they believed obesity was a disease that warranted compassionate treatment. But only 54% said a person’s weight would affect his or her future health “a lot” or an “extreme amount.”

Strikingly, only half of those with obesity actually perceived themselves as “obese” or “extremely obese.” Among the rest, 48% considered themselves “overweight” and 2% believed they were “normal weight.”

Small wonder perhaps, since only 71% said they had discussed their weight with their doctor in the last five years, and only 55% reported they had been diagnosed with obesity. Just 24% were offered follow-up care meant to treat their obesity, and 18% had committed to a weight-loss plan.

Even among those who had spoken with their doctors about their weight in the last six months, just 26% said they had committed to a weight-loss plan.

If patients felt they deserved more help from their doctors, they didn’t say so. Fully 82% believed that managing their weight was “completely their own responsibility.” And among obese respondents who had not sought weight-loss help from their doctor, this “it’s on me” belief was among the top two reasons cited.

Most doctors, meanwhile, know the stakes. More than half said they considered obesity “at least as serious” a health condition as high blood pressure, diabetes and congestive heart failure.

But 1 in 3 doctors who treat obese patients said they wait for the patients to broach the subject. Only 1 in 3 reported being “somewhat comfortable” or “a little comfortable” raising the issue.

Asked why patients don’t always seek their help, 65% of doctors posited that they were “too embarrassed to bring it up.” Only 15% of patients shared this view.

For their part, doctors frequently blamed time limitations for their failure to diagnose or treat obesity. Asked why they might not initiate discussions about weight loss, 52% cited “lack of time/the appointment was not long enough,” and 45% pleaded that they had to deal with “more important issues and concerns.”

The situation may sound bad, but Harvard endocrinologist Dr. Lee Kaplan said he sees signs of progress.

“There’s evidence in here that the healthcare community and employer community recognize the seriousness of obesity,” said Kaplan, a coauthor of the study.

Still, he added, doctors’ commitment to treating obesity “as you would any other disease” is not where it should be.

Many doctors are discouraged by the limited availability of effective treatments and wonder why they should bother, Kaplan said. He added that obesity has become so common that they fear “if they open up their practice to obesity treatment, they’ll be overwhelmed.”

Finally, he said, “there’s no imperative — moral, financial or otherwise — to treat obesity.” As a result, Kaplan said, some doctors “are taking the opportunity to overlook it.”



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