Weight Loss: Taking Action To See Results
Overview
Obesity rates in Latin America rank among the highest globally, with people with obesity (PWO) often receiving inadequate care due to various challenges and barriers. The international ACTION-IO study aimed to explore perceptions, attitudes, and behaviors of PWO and healthcare providers (HCPs) and to identify obstacles to effective obesity management. This specific subanalysis focused on the Chilean cohort, comparing characteristics, perceptions, attitudes, and behaviors based on the percentage of weight loss (lower weight loss [LWL; ≤10%] or higher weight loss [HWL; >10%] of initial weight).
In this survey, 1000 Chilean PWO and 200 HCPs participated. The average age of PWO was 38 years (ranging from 18 to 75), with 62% being female. Most participants had class I obesity. The HWL subgroup, comprising 17.2% of the Chilean sample, exhibited distinct characteristics: higher educational levels, fewer instances of class III obesity, a preference for consulting obesity specialists, and a positive perception of discussions with HCPs. These patients also reported better outcomes following HCP advice and were more likely to attend scheduled follow-up visits. Factors such as educational level, consulting obesity specialists, adherence to HCP advice, attending follow-up appointments, and awareness of obesity status were associated with a higher likelihood of significant weight loss.
In conclusion, obesity rates in Latin America are exceptionally high, and current care for PWO is often insufficient. The Chilean cohort of the ACTION-IO study revealed that higher educational levels, specialist consultations, adherence to medical advice, follow-up visits, and awareness of one’s obesity status are key indicators of a greater likelihood of substantial weight loss.
Introduction
Obesity is a pervasive, multifaceted, chronic condition characterized by an excess of body fat that detrimentally affects health, heightens the risk of long-term medical issues, and shortens lifespan. Recent data indicate that the financial impact of obesity on healthcare costs is greater than previously estimated. In 2016, the annual medical expenses due to obesity reached $260.6 billion in the United States, and in 2020, $28.1 billion in Brazil, Chile, and Colombia. The obesity epidemic is driven by a combination of physiological, genetic, environmental, and socioeconomic factors. This condition is linked to severe health complications, including hypertension, type 2 diabetes, chronic kidney disease, cardiovascular events, sleep apnea, and cancers such as endometrial and breast cancer, as well as social stigmatization.
Latin America experiences some of the highest obesity rates globally, with adult obesity rates ranging from 19.7% to 28.9%. In Chile, a national health survey from 2016-2017 revealed that 39.8% of the population is overweight, and 34.4% is obese.
Initial treatment for people with obesity (PWO) involves lifestyle changes and behavioral therapy. However, achieving clinically significant weight loss requires frequent and sustained interventions. In practice, PWO often receive suboptimal care due to numerous challenges and barriers, resulting in ineffective disease management. Enhancing obesity care necessitates a deeper understanding of obesity science, treatment approaches, and identifying gaps between current practices and optimal management.
The Awareness, Care, and Treatment in Obesity Management International Observation (ACTION-IO) study sought to identify perceptions, attitudes, and behaviors of both PWO and healthcare providers (HCP), as well as to uncover barriers to effective obesity care. Findings from the Chilean subset of the ACTION-IO study revealed misconceptions about obesity among both PWO and HCPs, underscoring the need for improved education on the biological aspects and clinical management of obesity. This subanalysis aimed to compare the characteristics, perceptions, attitudes, and behaviors of Chilean PWO in the ACTION-IO study, based on their weight loss percentage (≤10% or >10% of initial body weight). A weight loss of over 10% is associated with significant health benefits, such as reduced blood pressure, heart rate, systolic workload, and decreased cardiovascular events, which is critical considering that cardiovascular disease is the leading cause of death in Chile.
Method
The ACTION-IO (NCT03584191) study aimed to gather data on perceptions, behaviors, and awareness regarding obesity and its management from both people with obesity (PWO) and healthcare professionals (HCPs) who treat obesity. This cross-sectional, non-interventional, descriptive study utilized an online survey to collect data from participants in Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, the United Kingdom, and the United Arab Emirates. The study employed two questionnaires—one for PWO and one for HCPs—developed by an international steering committee of obesity experts and the study sponsor. The outcomes were measured through various methods including multiple item selection (e.g., weight loss motivators), numeric responses (e.g., the proportion of PWO making serious weight loss efforts), single item selection, Likert agreement scales (e.g., attitudes towards obesity), and ranking (e.g., factors for improving weight loss outcomes).
In Chile, participants completed the survey between June 4 and July 25, 2018. Eligible PWO were adults (≥18 years old) with a BMI of ≥30 kg/m², based on self-reported height and weight. In questions related to weight management conversations and outcomes, ‘HCP’ included general physicians, medical specialists, non-physician dietitians, pharmacists, nurses, or diabetes educators. For all other questions, ‘physician’ was used. All respondents provided electronic informed consent before starting the screening questions and survey.
In a subgroup analysis, PWO who reported achieving weight loss greater than 10% (higher weight loss [HWL]) were compared with those who had not achieved such weight loss (lower weight loss [LWL]). The main results were categorized into four topics: acknowledging obesity, weight loss goals, motivations for weight loss, and attitudes towards specific treatments. This categorization aimed to identify perceptions, behaviors, and potential barriers to effective obesity care among PWO and HCPs, as well as to address knowledge gaps in this field in Chile.
Continuous variables were summarized using mean and standard deviation or median, range, and quartiles, depending on their distribution. Categorical variables (including Likert scale results) were summarized using percentages. Depending on the distribution of quantitative variables, parametric or non-parametric tests, as well as chi-square or Fisher’s exact tests for categorical variables, were utilized. Missing values were not imputed. Statistical significance was determined at p < .05. Data analysis was conducted using IBM SPSS® Statistics v20.0.0 software. Due to the exploratory, descriptive nature of the ACTION-IO study, no adjustments for multiple testing were initially performed.
Result
The ACTION-IO survey in Chile included responses from 1000 people with obesity (PWO) and 200 healthcare professionals (HCPs), with response rates of 20% and 29% respectively. The average age of PWO was 38 years, 62% were female, and most had class I obesity (BMI: 30.0–34.9 kg/m²). A subgroup focused on higher weight loss (HWL) made up 17.2% of the total. There were no significant differences in median BMI, age, gender distribution, income, and comorbidity prevalence between the HWL and lower weight loss (LWL) groups. However, the HWL group had a higher educational level and fewer cases of class III obesity.
All PWO indicated that conditions like diabetes, stroke, cancer, COPD, and obesity significantly impact overall health, with no notable perception differences between HWL and LWL groups. The average ages at which PWO started struggling with excess weight and first discussed it with an HCP were 24 and 27 years, respectively, with no differences between the subgroups. Both groups reported a median of three serious weight loss attempts over their lifetimes.
HWL participants more frequently discussed their weight with obesity specialists and surgeons and found these conversations more helpful than LWL participants. HWL patients were more likely to consult cardiologists about weight issues compared to LWL patients. After discussing weight with HCPs, HWL patients were more likely to follow HCPs’ advice successfully, while LWL patients often stopped or were unsuccessful in following suggestions. Among PWO who had not discussed weight loss with their HCPs, a high percentage planned to schedule a visit or phone consultation, with no significant difference between the subgroups.
HWL patients had higher follow-up appointment attendance rates compared to LWL patients. In terms of weight management goals discussed with HCPs, HWL patients focused more on improvements in physical/mental health and well-being and a specific reduction in body weight. Both groups had similar personal weight management goals.
HWL patients tried more specific or elimination diets, meal/nutrient tracking systems, prescription medicines, and visited obesity specialists more frequently than LWL patients. There was a trend towards HWL patients trying behavior therapy or psychotherapy. HWL patients continued to use meal/nutrient tracking and prescription medicines more often than LWL patients.
HWL patients more frequently obtained weight management information from their HCPs. They were also more motivated and had different attitudes toward weight loss, disagreeing with statements like “I know how to lose weight” and “I am happy with my current weight” more than LWL patients. Barriers to weight loss for LWL patients included a preference for unhealthy food and lack of motivation, with no significant differences in other barriers like access to healthy food or medication costs.
Both subgroups had similar attitudes toward prescription obesity medications, but HWL patients had more concerns about the safety of weight loss surgery and were more likely to discuss it with their HCPs and recognize the lifestyle changes it would require.
Conclusion
This subanalysis of Chilean data from the ACTION-IO study identifies specific characteristics of patients who achieve higher weight loss (HWL). These patients tend to have higher educational levels, fewer instances of class III obesity, a preference for consulting obesity specialists, and find discussions with healthcare providers (HCPs) highly beneficial. Additionally, HWL patients report better outcomes following HCP advice and are more likely to attend follow-up visits.
The study highlights a connection between lower educational attainment and overall obesity. A systematic review showed that weight loss interventions targeting individuals with low educational levels, delivered in schools, communities, and primary care settings, are effective in the short term. Retrospective data suggest that online and workplace weight loss programs can be effective regardless of educational level. The local prospective data indicate an association between education and weight loss magnitude in patients with obesity (PWO), meriting further investigation.
Both HWL and lower weight loss (LWL) patients began struggling with obesity and discussing it with an HCP around the ages of 24 and 27, respectively. However, HWL patients were significantly more likely to adhere to follow-up appointments. This suggests that barriers such as healthcare access and HCP-driven factors in low socioeconomic settings may limit consultations for LWL patients.
Patients who lost more than 10% of their body weight showed a strong preference for consulting obesity specialists, indicating that HCP training plays a crucial role in achieving favorable outcomes. The World Obesity Federation recognizes obesity as a chronic relapsing disease, significantly burdening primary care due to its association with type 2 diabetes, coronary heart disease, and certain cancers. International guidelines recommend referring patients with a BMI ≥40 kg/m² or ≥35 kg/m² with comorbid conditions to obesity specialists. Enhanced HCP training, including for general practitioners, could improve the diagnosis and management of PWO, providing up-to-date treatments.
HWL patients viewed HCP visits as highly valuable for weight loss and information. Increasing follow-up appointments, referrals to specialists, and evidence-based treatments can enhance obesity management and physician-PWO communication. HWL patients also reported HCPs as a crucial information source, emphasizing the importance of medical training on treatment adherence.
Differences in weight loss attitudes between LWL and HWL patients were noted, with HWL patients being more aware of their weight issues and more comfortable discussing them with HCPs. HWL patients also demonstrated higher motivation to lose weight. The point at which patients become aware of their obesity and associated health risks is crucial for significant weight reduction efforts.
This subanalysis shares the limitations of the ACTION-IO study, including its cross-sectional, descriptive design, potential bias from self-reported data, lack of adjustment for confounding variables, and possible reverse causality. Despite these limitations, the study’s strengths include a large sample size, scientifically robust survey questions, and representative screening criteria for the general Chilean population.
In conclusion, demographic and behavioral factors, particularly educational level, consultation with obesity specialists, adherence to HCP advice, follow-up visits, and obesity awareness, are key indicators of higher weight loss probability in PWO. Combining patient-oriented strategies can lead to effective policies for early treatment and specialist referral. Training HCPs in obesity science and management and developing multidisciplinary teams for PWO are crucial for treating obesity as a chronic, recurrent disease. Further research is needed to understand the relationship between patient characteristics and HCP impact on achieving significant weight loss.
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