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Survey finds COVID-19 pandemic changed public’s view of obesity

Nearly a third of Americans (29%) say COVID-19 made them more worried than ever about having obesity prompting about 28 million people to consider weight-loss methods they hadn’t thought about before the pandemic began, including nearly 6.4 million who thought about turning to either bariatric surgery or taking prescription anti-obesity drugs for the first time, according to a survey by researchers from NORC at the University of Chicago.

Survey question: Was the COVID-19 pandemic a major reason, minor reason, or not a reason at all for trying to lose weight this year? (Answer choices: major reason, minor reason, not a reason at all.). Credit: Surgery for Obesity and Related Diseases (2023). DOI: 10.1016/j.soard.2023.02.020

In addition, nearly one in five people (18%) said they were more likely to initiate a discussion about their weight with their physician specifically because of concerns about COVID-19 – a percentage that grew to nearly a third among Black (28%) and Hispanic Americans (29%), and individuals with obesity (27%).

Teresa LaMasters

The nationally representative public opinion survey of more than 1,700 adults was conducted by NORC and the American Society for Metabolic and Bariatric Surgery (ASMBS), at the end of 2021, more than two years into a pandemic where obesity emerged as a major risk factor for hospitalization and death from COVID-19. The ASMBS Foundation, a non-profit dedicated to obesity research, education and advocacy, provided financial support for the survey.

“Our hope is that people turn the fear of obesity and the consideration of new weight-loss strategies into action,” said Dr Teresa LaMasters, a bariatric surgeon, a board-certified obesity medicine physician, and president of the ASMBS. “With greater eligibility for weight-loss surgery and the emergence of effective new anti-obesity medications, Americans have more and better options than ever before, and they should take advantage of them when appropriate. Talk to your doctor.”

“We’ve definitely seen a significant rise in interest in weight-loss surgery and other underutilized treatments since obesity was linked to worse outcomes from COVID-19,” said Dr Shanu N Kothari, co-author of the study and immediate past president of the ASMBS, the nation’s largest organisation for bariatric surgeons and integrated health professionals focused on obesity. “COVID-19 lit the match for many people to get healthier and protect themselves from severe disease, whether that be COVID-19, diabetes, or heart disease. Treating obesity, the source of so many of these diseases, is the best way.”

The findings were reported in the paper, ‘When the COVID-19 Pandemic Collides with the Obesity Epidemic in America -- A National Survey’, were published in the peer-reviewed journal, Surgery for Obesity and Related Diseases (SOARD). The survey also found more than 90% with obesity have tried to lose weight at some point in their lives, with 70% of this group still trying. Amid the pandemic, more than 60% of those who attempted a new approach to weight loss said they considered diet and exercise, followed by working with a doctor (37%), taking anti-obesity prescription medications (15%) or getting weight-loss surgery (13%), which is far more than the number who receive either treatment each year.

According to the ASMBS, only about 1% of those who meet the recommended body mass index (BMI) criteria for weight-loss surgery currently have it in any given year. In 2020 the number of bariatric procedures dropped to less than 200,000, the lowest in four years, due to cancellations or deferrals during the height of the pandemic. Approximately 1% to 3% of people take prescription medicines for obesity.

Around eight in ten adults (82%) think obesity is the biggest health threat facing the country, as big as cancer (82%), and even more significant than heart disease (77%), diabetes (76%), and COVID-19 (68%). Only Black Americans considered COVID-19 more dangerous than obesity (87% vs. 81%), cardiovascular disease (87% vs. 83%) or cancer (87% vs. 85%). Even so, more Black and Hispanic adults were more worried about the dangers of obesity than the general population (45% vs. 29%).

Despite the real and perceived threat of obesity, most people do not go beyond traditional diets or involve doctors in their attempts to lose weight and overestimate the effectiveness of some treatments while underestimating others. Nearly three-quarters (73%) considered dieting and exercising on their own to be the most effective method for long-term weight loss, even more effective than involving a doctor (65%) or weight-loss surgery (56%), the latter of which has been shown to produce the greatest and most durable weight loss and health benefits among people with obesity.

Only 23% deemed taking prescription medications or dietary supplements (18%) as effective. When it comes to safety, more Americans correctly believe someone would have a greater chance of dying from the complications of obesity (47%) or COVID-19 (39%) than weight-loss surgery (19%).

“Our latest survey reveals significant misperceptions persist regarding the nature of obesity and its causes, as well as a lack of dialogue between most doctors and patients when it comes to discussing and understanding the impact of excess weight on health,” said lead researcher, Dr Jennifer Benz, Vice President, Public Affairs and Media Research at NORC. “When it does happen, it’s more often initiated by the patient.”

The survey found that the public thinks differently about obesity than the medical community. Most Americans view it as a risk factor (61%) for other diseases rather than a disease itself, and nearly three-quarters (73%) of those who have tried to lose weight cite a lack of willpower as a barrier to losing weight – percentages that have not changed since the 2016 ASMBS-NORC Obesity in America Survey. The American Medical Association, the nation’s largest physician group, classifies obesity as a disease caused by a combination of biological, genetic, social, and environmental factors.

New ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery – 2022 were issued expanding patient eligibility for weight-loss surgery and endorsing metabolic surgery for patients with type 2 diabetes beginning at BMI of 30. The guidelines also recommend bariatric surgery for individuals with a BMI of 35 or more “regardless of presence, absence, or severity of obesity-related conditions” and that it be considered for people with a BMI 30-34.9 and metabolic disease and in “appropriately selected children and adolescents.” But even without signs of other diseases, the guidelines say surgery should be considered starting at BMI 30 for people who have not had success with nonsurgical methods.

To access this paper, please click here


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