A groundbreaking international survey conducted across seven countries has unveiled a profound disjunction between the perceptions of adults living with obesity and their treating physicians regarding the causes and treatment goals of obesity. The results, presented at the prestigious European Congress on Obesity (ECO) held in Malaga, Spain, provide compelling evidence that entrenched biases and misconceptions continue to cloud the understanding of obesity as a complex chronic disease. This misalignment has substantial implications for patient care, access to evidence-based treatment, and the broader public health response to one of the world’s most pressing health challenges.
Despite evolving scientific consensus recognizing obesity as a multifactorial and relapsing chronic disease, many healthcare providers and patients alike still interpret obesity primarily through the lens of individual behavior, specifically focusing on diet, exercise, and motivation. Dr. Ximena Ramos Salas from K&X Ramos AB, Sweden, highlights how this reductionist viewpoint persists, explaining that such beliefs essentially frame obesity as a failure of personal willpower rather than acknowledging the intricate biological, genetic, and environmental determinants. This reductionism fosters stigma and blame, undermining the compassionate, comprehensive care that individuals with obesity urgently need.
The survey, orchestrated by a collaborative team including researchers from Eli Lilly and Company, Adelphi Real World, and the University of Rome Tor Vergata, analyzed data collected between October 2023 and April 2024. It drew on responses from both physicians and patients in France, Germany, Italy, Spain, the UK, the USA, and Australia. Physicians documented clinical insights from their initial eight consultations with adults diagnosed with obesity, defined by specific body mass index (BMI) thresholds and the presence of obesity-related complications. Concurrently, the patients completed a voluntary questionnaire reflecting their personal beliefs about what causes their obesity and their aspirations for treatment outcomes.
A critical discovery from this extensive data set—comprised of 1,379 physician-patient pairs—is the stark contrast in how the causes of obesity are perceived. Physicians predominantly cited behavioral factors with an alarming frequency: overeating was identified in nearly 70% of cases, lack of physical exercise in 61%, and diets high in fat in 51%. Additionally, almost half attributed obesity to a lack of patient motivation. These behavioral attributions intensified with the severity of obesity, particularly in patients classified under the highest obesity class (Class III), signaling a potential bias that sees more severe cases as failures of personal conduct rather than more complex disease severities.
Conversely, while patients similarly recognized behavioral and socioeconomic factors as important, their attributions exhibited a markedly greater emphasis on biological causes. A striking 81% of individuals with obesity acknowledged biological drivers such as genetics, hormonal imbalances, and metabolic factors, compared to only 61% of physicians. Notably, genetics ranked as the third leading perceived cause among patients but was scarcely considered by most physicians, who positioned it seventh. This discrepancy underscores the need for physicians to broaden their conceptual frameworks and therapeutic approaches beyond lifestyle modification alone.
The divergence in perceptions extends beyond causation to encompass treatment goals, revealing profound differences in priorities between physicians and those living with obesity. Physicians predominantly frame treatment success through the lens of measurable health metrics: enhancing overall quality of life, increasing physical mobility, and reducing cardiovascular risk factors such as hypertension are common focal points. These clinical endpoints remain essential yet often overlook the psychosocial dimensions that profoundly influence patient engagement and long-term health.
In sharp contrast, patients expressed aspirations deeply rooted in psychosocial outcomes. Two-thirds articulated hopes focused on how losing weight would affect their self-confidence, emotional well-being, and social integration, including desires to fit into smaller clothing sizes and feel better about their appearance. These goals reflect a broader understanding that obesity’s impacts extend beyond physiology, encompassing significant psychological distress and social stigma.
Dr. Ramos Salas eloquently emphasizes the pivotal role physicians must play in reconciling these disparate perspectives. She urges healthcare providers to adopt a more holistic, empathetic approach that integrates physical health improvements with psychosocial support. Addressing internalized weight stigma, empowering patients through body acceptance, and mitigating self-blame represent vital components of modern obesity care that transcend traditional biomedical models.
This study’s findings carry profound implications for clinical practice, healthcare policy, and public education. The prevailing physician tendency to foreground behavioral causation and clinical outcomes risks perpetuating stigma and may inadvertently limit patients’ access to comprehensive, evidence-based interventions such as pharmacotherapy and bariatric procedures. Moreover, failure to recognize and prioritize patient-defined goals may erode trust, engagement, and adherence, ultimately compromising treatment efficacy.
From a research and clinical perspective, the deployment of the Edmonton Obesity Staging System (EOSS) alongside BMI classification in this survey provided nuanced insight into how severity and comorbidities correlate with attitudes and treatment goals. EOSS, a five-point scale evaluating obesity-related complications, allows a more patient-centered approach by integrating health risks and quality of life factors, yet this complexity remains underappreciated among many clinicians.
The scientific community must also grapple with the entrenched social biases surrounding obesity. Public narratives often reinforce simplistic notions of personal culpability despite mounting evidence elucidating obesity’s roots in genetics, neuroendocrine regulation, and socioeconomic determinants. This biomedical and social discourse gap not only marginalizes people living with obesity but also obstructs policy innovations required to address systemic contributors such as food environments, urban design, and socioeconomic disparities.
Going forward, interventions must prioritize education for providers that challenge weight bias and improve the competency to deliver person-centered care. Equally, patient empowerment through informed dialogue about the multifactorial nature of obesity can enhance self-efficacy and motivate sustainable health behaviors. Interdisciplinary collaboration integrating endocrinology, psychology, nutrition, and social sciences holds promise for advances in both research and clinical pathways.
This international survey serves as a wake-up call at a critical juncture in the global obesity epidemic. While the clinical community has made strides in characterizing obesity as a chronic disease, outdated perceptions persist, influencing care delivery in ways that may unwittingly hinder progress. By reorienting both perceptions and priorities, the potential exists to dismantle barriers, reduce stigma, and improve outcomes for millions worldwide living with obesity.
For researchers, clinicians, and policymakers alike, the message is clear: obesity treatment must transcend simplistic behavioral models and embrace a comprehensive, nuanced understanding that aligns clinical goals with patient aspirations. Only through such alignment can healthcare systems hope to reverse the tide of this complex and multifaceted disease.
Subject of Research: Physicians’ and patients’ perceptions of obesity causes and treatment goals
Article Title: Not specified in the source document
News Publication Date: 13-May-2025
Web References:
Figures 1 and 3: https://drive.google.com/file/d/1D7Gnnpw-7G4F6JGzoshnjyYmHkETQmtN/view?usp=sharing
Full abstract: https://drive.google.com/file/d/1G2Z_NOgMo3z_F_Ed2NW2LSRSNMWYj9UB/view?usp=sharing
References: The press release is based on a poster presentation at the European Congress on Obesity (ECO), peer-reviewed by the congress selection committee; full journal publication pending.
Image Credits: Not provided
Keywords: obesity, chronic disease, weight bias, stigma, patient perceptions, physician perceptions, treatment goals, behavioral causes, biological causes, Edmonton Obesity Staging System, BMI, psychosocial outcomes
Tags: biases in obesity carechronic disease understandingevidence-based obesity treatmenthealthcare provider misconceptionsinternational obesity survey resultsmultifactorial obesity causesobesity as a complex diseaseobesity perceptions gapobesity treatment goalspatient doctor communicationpublic health implications of obesitystigma surrounding obesity
