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Survey: Physicians rate weight-loss medications, surgery less effective than lifestyle in obesity management

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December 11, 2017

Adam Tsai
Adam Gilden Tsai

Primary care physicians and obesity medicine specialists rated behavioral factors as a greater cause of weight gain vs. biological factors, and rated weight-loss medications and bariatric surgery as less effective relative to lifestyle modification, according to recent survey data.

The data, gathered from questionnaires administered at CME courses and 2 consecutive years of an obesity medicine course, also showed that physicians who practice obesity medicine gave higher effectiveness ratings for medications and bariatric surgery relative to PCPs.

“However, even [obesity medicine specialists] gave lower ratings for medications, relative to lifestyle modification alone,” the researchers wrote. “Thus, both groups of physicians have incorrect impressions regarding the efficacy of treatment, highlighting the need for more physician education.”

Adam Gilden Tsai, MD, MSCE , clinical lead in adult obesity at the Kaiser Permanente Care Management Institute and associate professor at the University of Colorado School of Medicine, and colleagues administered a questionnaire to address five biological factors and two behavioral factors implicated in weight gain, as well as the perceived effectiveness of behavioral, pharmacologic and surgical treatment of obesity. All items were rated on a scale of 0 to 10, with 0 listed as “least important.” The questionnaire was administered at a Kaiser Permanente primary care CME course (n = 35) as well as a state-level CME conference of the American College of Physicians (n = 126), in addition to 2 consecutive years of an obesity medicine course run by The Obesity Society (n = 111). Researchers used paired t tests to compare item scores and summary scores between PCPs and obesity medicine specialists. The mean age of respondents was 47 years; obesity medicine specialists were on average 4.3 years older than PCP responders, and more obesity medicine specialists were women vs. PCPs (56.1% vs. 46.8%).

Respondents overall gave higher importance ratings to behavioral factors vs. biological factors as causes of obesity (mean, 8.27 vs. 6.65 on a 10-point scale; P < .001 for difference). There were no between-group differences in ratings for PCPs vs. obesity medicine specialists.

Additionally, both PCPs and obesity medicine specialists rated weight-loss medications as less effective than both lifestyle medication and bariatric surgery (P < .001 for both); bariatric surgery was rated as less effective than lifestyle modification alone (P = .002). There were no between-group differences in ratings for the effectiveness of lifestyle modification, but obesity medicine specialists have higher ratings for the effectiveness of medications and bariatric surgery vs. PCPs.

“Physicians should understand that reductions in metabolism, as well as neurohormonal changes that increase appetite, tend to occur when patients lose weight,” Tsai told Endocrine Today. “Thus, when patients regain their weight, is not just behavior alone. Additionally, both weight-loss medications and weight-loss surgery produce additional weight loss beyond just diet and exercise alone.

“Physicians should educate themselves on the nature of obesity as a chronic metabolic disease,” Tsai said. “Organizations that provide CME and maintenance of certification should include more education about obesity specifically, to give physicians an incentive to learn more about obesity as a disease.” – by Regina Schaffer

For more information:

Adam Gilden Tsai, MD, MSCE, can be reached at Kaiser Permanente, Franklin Medical Office, Metabolic-Surgical Weight Management, 2045 Franklin St., 3rd Floor, Denver, CO 80205; email: adam.tsai@kp.org.

Disclosure: One of the study authors reports he receives consultant fees from Enteromedics, Novo Nordisk and Nutrisystem.

itj+ Perspective

Scott Isaacs
Perspective

This is a limited study, but it suggests that physicians tend to rate the treatments for obesity that are least effective as the best, and those that are the most effective as the least. There is this paradox that we see, and part of it stems from obesity bias. There is this belief, not just among physicians, but among patients, that you just tough it out, with diet and exercise, you should be able to lose weight, without medications or other interventions. Obesity specialists, of all people, should know the data, but they still rank diet and exercise higher than other interventions.

Our treatments for obesity are not good enough. Clinical trials show that medications may be better than diet and exercise, but they’re not that much better, with an average weight loss of 10%, and you must keep taking the medication. Realistically, in the long term, it is not ideal. Still, physicians as a whole need to embrace the best treatments, even if they are not as good as we might like them to be.

Scott Isaacs, MD, FACP, FACE

Clinical Instructor of Medicine
Emory University School of Medicine
Spokesperson, The Obesity Society

Disclosure: Isaacs reports that he serves on the speaker’s bureaus for Novo Nordisk and Orexigen.