Acta Scientific Medical Sciences (ISSN: 2582-0931)

Research ArticleVolume 5 Issue 4

Physicians and Patients’ Awareness About the Risks, Impacts, and Management of Obesity in the Gulf Region; A Cross-sectional Study

Salman K Al-Sabah1, Noor Al Busaidi2, Dalal Al Romaihi3, Mohammad H Jamal4, Saud Al Sifri5* and Emad R Issak6

1Director of Surgical Research and Academic Program in the Department of Surgery, Consultant Surgeon, Al Amiri Hospital, Kuwait
2Chairperson, Oman Diabetes Association, Director, National Diabetes and Endocrine Center. Royal Hospital, Ministry of Health, Oman
3Consultant Endocrinologist, King Hamad University Hospital, Bahrain
4Associate professor, Kuwait University, Program Director, Kuwait Institute for Medical Specialization, Kuwait
5Chairman of Endocrinology and Diabetes Department Alhada and Taif Armed Forces Hospitals, Saudi Arabia
6Internal Medicine, Researcher, Faculty of Medicine, Ain-Shams University, Cairo, Egypt

*Corresponding Author: Emad R Issak, Internal Medicine, Researcher, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.

Received: February 16, 2021; Published: March 05, 2021

Citation: Salman K Al-Sabah., et al. “Physicians and Patients’ Awareness About the Risks, Impacts, and Management of Obesity in the Gulf Region; A Cross-sectional Study”. Acta Scientific Microbiology 5.4 (2021): 04-13.

Abstract

  Obesity is a significant health problem that reduces life expectancy and the quality of life. This cross-sectional two-arm study aimed to test the physicians' and individuals' level of awareness of obesity and its consequences. The physicians' arm was conducted upon 104 registered physicians licensed to practice in one of in Gulf cluster countries (Kuwait, Qatar, Oman and Bahrain) who deal with patients with obesity. The obese-patients' arm was conducted upon 2337 patients in the same countries.

  The most frequent main modifiable reason for the increase in obesity, according to physicians, is the lack of self-control. Reduction in motivation and lack of compliance is the most likely contributors to weight gain after a period of weight loss. In addition, they see that 10-15 kg weight loss or 5-10% weight loss from baseline weight gives significant improvements in health in terms of reducing body weight. The most optimal lifestyle treatment strategy is diet, exercise, and CBT. Not all physicians believe that they are responsible for actively contributing to their patient's successful weight loss efforts. The more significant part of the physicians was not aware of their role to educate people with obesity. Physicians are reluctant to initiated talk about weight with patients.

  More than half of obese patients mentioned that obesity affects their lifestyle, physical health, social life, and romantic relationships. Obesity increases the risk of developing significant outcomes like arthritis, heart disease, fatty liver, hypertension, and kidney failure. The majority of them view that obesity is a lifestyle choice. They perceived that it is less serious and found it as a cosmetic issue. Financial issues are significant barriers to attempts to lose weight, followed by lack of information. Prescription medications are the most frequent methods that they are currently using or have tried to use in the past to lose weight, followed by diet and exercise and dietary supplements.

Keywords: Obesity; Awareness; Outcomes; Management

Introduction

  Obesity is a significant health problem that reduces life expectancy and the quality of life [1]. According to WHO estimation in 2016, around the world, more than 1.9 billion of those 18-years of age or older were overweight, and over 600 million have been diagnosed as obese [2]. That increase in prevalence has been particularly intense in the Gulf region, like Saudi Arabia, Bahrain, Qatar, Kuwait, Oman, and the United Arab Emirates [3,4].

  Gulf countries have the highest rate of obesity. Kuwait, Bahrain, Saudi Arabia, and the United Arab Emirates are in the list of top ten countries worldwide in terms of obesity [2]. The prevalence of obesity in Gulf Countries among children and adolescents ranges from 5% to 14% in males and 3% to 18% in females. There is a significant increase in obesity in adult females, with a prevalence of 2%-55% and adult males 1%-30% in the Gulf region countries [3].

  Also, in Saudi Arabia (KSA), according to the data from the World Atlas about the most obese countries in the world, KSA is the world 14th most obese country, with an overall obesity rate of 35.4%; which has resulted from less regular exercise or physical activities, increased consumption of western fast food, and the use of large community platters [5,6]. According to the WHO health profile of Saudi Arabia 2015, which was based on the data from the Saudi Ministry of Health, the prevalence of low levels of physical activity is 60.3% (46.0% males, 75.1% females). Obesity affects 28.7% of the population (24.1% males, 33.5% females). A serious challenge affecting the country is the rise in childhood obesity, affecting approximately 6-10% of preschool and school-age children [7,8].

Obesity has a strong association with many risk factors like hormones, high food intake, sedentary lifestyle, low socioeconomic status, and smoking [9].

  Else, it is associated with many co-morbidities, including cardiovascular, diabetes, respiratory, sleep apnea, joint diseases, gastrointestinal, and some types of malignancy [10-12]. The increased prevalence of obesity has a disastrous financial burden at the governmental and the individual level [13,14].

  Of course, the first step to developing useful interventions to minimize this health problem is estimating the prevalence rate and the level of awareness at the individual level and the health care professional level.

Therefore, this study's rationale was to test the physicians' and individuals' level of awareness of obesity and its consequences.

Methods

  A two-arm (physicians and patients) cross-sectional study. The physicians’ arm was conducted upon 104 registered physicians licensed to practice in one of in Gulf cluster countries (Kuwait, Qatar, Oman and Bahrain) who deal with patients with obesity. The survey was emailed to virtually 160 physicians in the Gulf Cluster countries within a healthcare professional panel database (response rate: 65%). The emails were sent from early February 2020 through early April 2020. The survey included 17 separate MCQs, with multiple responses possible on some questions. The survey was brief (estimated time to complete was 10-15 minutes), and responses were kept anonymous. The total number of surveys received was 104. The margin of error for all questions was calculated, and it was +/-1.057%.

  The obese-patients’ arm was conducted upon 2337 patients in one of the Gulf cluster countries (Kuwait, Qatar, Oman and Bahrain). The survey included 16 separate MCQs, with multiple responses possible on some questions. The survey was brief (estimated time to complete was 10-15 minutes), and responses were kept anonymous. The survey was emailed to virtually 4000 obese patients in the Gulf Cluster countries. The total number of surveys received was 2337 (response rate = 58%). The margin of error for all questions was calculated, and it was +/-1.123%. The purpose of the study was explained to participants at the start of the questionnaire. The final questionnaire was developed after pilot testing among 30 physicians and 100 patients, and necessary modifications were carried out.

  The administered questionnaire included the following sections—demographic data including country, gender, age, nationality, and specialty for the physicians' arm. Knowledge of participants was assessed by asking them about different aspects of obesity, including lifestyle, knowledge about morbidity associated with obesity, and management of obesity. For the patients' arm, the administered questionnaire included the following sections: demographic data including country, gender, age, nationality, and BMI.

  Knowledge of participants was assessed by asking them about different aspects of obesity, including lifestyle, knowledge about morbidity associated with obesity, and management of obesity.

  The survey responses were entered into the SPSS software (version 17.0) and checked for any errors or missing information. Demographic characteristics were assessed using means for continuous variables and proportions for categorical variables.

Results

Physicians’ arm Demographics

  Most (70.2%) of the 104 enrolled physicians belong to 35-54 years. Almost half of them were male (51.9%). They are practicing in the four Gulf countries: Kuwait 27.9%, Bahrain 30.8%, Qatar 32.7%, and Oman 8.7%. GP and family medicine constituted the majority (66.3%) of the enrolled physicians (Table 1).

 

n

%

Age Range (Years)

   

35-44

34

32.7%

45-54

39

37.5%

55-64

20

19.2%

65-74

11

10.6%

Gender

Male

54

51.9%

Female

50

48.1%

Country

Kuwait

29

27.9%

Bahrain

32

30.8%

Qatar

34

32.7%

Oman

9

8.7%

Specialty

GP

39

37.5%

Family medicine

30

28.8%

Endocrinologist

26

25.0%

Bariatric surgeon

9

8.7%

Table 1: Physicians’ demographics.

Physicians’ insight into obesity

  The most frequent main reason for the increase in overweight and obesity, according to physicians, is the lack of self-control (28.8%) followed by the genetic predisposition in addition to in-activity and overabundance of food (26.0%). Reduction in motivation and lack of compliance is the most likely contributor to weight gain after a period of weight loss (42.3%). The least associated comorbidity with obesity, as mentioned by physicians, is osteoporosis (44.2%), followed by male infertility (30.8%), table 2.

n

%

1. Which of the following statements is the main reason for the increase in overweight and obesity?

a) Lack of self-control

30

28.8%

b) Genetics

15

14.4%

c) Genetic predisposition in addition to in-activity and overabundance of food

27

26.0%

d) Increasing use of medications that can lead to weight gain

13

12.5%

e) Endocrine causes

19

18.3%

2. Weight gain (WG) after a period of weight loss (WL), is one of the most profound challenges in obesity management. Which of the following statements represents the most likely contributor?

a) Reduction in motivation and lack of compliance

44

42.3%

b) Reduction in RMR*and a decrease in energy expenditure related to PA**

20

19.2%

c) Increase in hunger sensation and a decrease in satiety due to physiological adaptations to appetite control systems

12

11.5%

d) Combination of all of the above

28

26.9%

3. Which diagnostic criterion regarding obesity represents the current standard?

a) BMI (kg/m')

58

55.8%

b) Presence of comorbidities

27

26.0%

c) Body composition (fat-free mass vs. fats)

7

6.7%

d) Amount of Visceral adipose tissue (VAT)

12

11.5%

4. When diagnosing obesity in children, which of the following tool is the best one to use?

a) BMI curve

35

33.7%

b) Waist-to-hip ratio

22

21.2%

c) Iso-BMI curve

7

6.7%

d) Percentiles

40

38.5%

5. Which of the patients would you most likely prioritize in terms of treatment for obesity?

a) Female 38 yrs old, BMI 50 kg/m2. mild hypertension, knee and LBP

70

67.3%

b) Male 34 years old, BMI 35 kg/m2, Diabetes type 2, obstructive sleep apnea

21

20.2%

c) Female 48 years old, BMI 32 kg/m physically active, small joint discomforts

3

2.9%

d) Male 36 years old, BMI 45 kg/, impaired fasting glucose, mild depression

10

9.6%

6. Which statement in terms of reduction in body weight gives significant improvements in health?

a) 10-15 kg WL

43

41.3%

b) 5-10% WL from baseline weight

33

31.7%

c) A reduction in BMI category (e.g. from WHO class III to WHO class II)

10

9.6%

d) A reduction in waist circumference (cm) by 10%

18

17.3%

7. What is the most optimal strategy for lifestyle treatment of obesity?

a) Changing dietary habits

25

24.0%

b) Combination of diet and exercise

18

17.3%

c) Increasing physical activity levels (PALS)

20

19.2%

d) Cognitive behavioral therapy (CBT)

4

3.8%

e) Combination of diet, exercise and CBT

37

35.6%

8. When considering long-term weight reduction, which diet is the most effective one?

a) Low carbohydrate-high fat (LCHF)

37

35.6%

b) Low fat

26

25.0%

c) Mediterranean diet

17

16.3%

d) Any diet can give the same weight reduction given equal negative energy balance and long-term compliance

24

23.1%

9. Which of the following statements is the most appropriate recommendation when looking at conservative treatment of obesity?

a) A negative energy deficit of approximately 600 kcal/day

19

18.3%

b) <20% of the energy in the clied cum from Cuts a macronutrient

7

6.7%

c) A weight loss of >1.0kg/week

28

26.9%

d) A diet very low in energy (<300 kcal/day)

50

48.1%

10. Which of the following statements is the most correct one when looking at long-term outcomes of surgical treatment of obesity (Gastric ByPass, GHPJ)?

a) GBP improves the metabolic risk profile, but not primarily cardiovascular risk

11

10.6%

b) 15% of patients experience suboptimal weight loss or significant weight regain

16

15.4%

c) GBP does not produce a more significant WL after two years when compared to lifestyle treatment of obesity

17

16.3%

d) 95% of patients who undergo GBP respond well when looking at WI.

60

57.7%

11. Which of the following statements represents the most common complication after GBP?

a) Hypertension

6

5.8%

b) Dyslipidemia

8

7.7%

c) Low levels of vitamin B12, vitamin D, calcium, and iron

51

49.0%

d) Osteoporosis

39

37.5%

12. Which of the following comorbidities is least associated with obesity?

a) DM

10

9.6%

b) Osteoporosis

46

44.2%

c) Male infertility

32

30.8%

d) Non-alcoholic fatty liver disease (NAFLD)

16

15.4%

13. Which level of physical activity is recommended to maintain weight loss?

a) 30 min/day moderate intensity

41

39.4%

b) Short 10 min bouts with high intensity 3 times/week

22

21.2%

c) 45-60 min/day moderate intensity

24

23.1%

d) 30 min High intensity 3 times/week

18

17.3%

14. On average, which percentage do Individuals who have lost weight through lifestyle changes are able to maintain a clinically significant WL for at least 1 year!

a) 20%

62

59.6%

b) <10%

6

5.8%

c) 30%

24

23.1%

d) 40%

12

11.5%

15. Which of the following statements is most associated with long-term WL maintenance?

a) A diet high in carbohydrates (55% of total energy intake)

24

23.1%

b) Exercising at high intensity > 3 times/week

40

38.5%

c) Eating breakfast 5 days/week

33

31.7%

d) Self-weighing I times/month

7

6.7%

16. Choose the statement you agree the most with regarding possible reasons for you as a doctor feeling resistant to initialize treatment of obesity.

a) There is not much I can accomplish during a 10-min consultation

29

27.9%

b) Obesity is a very complex condition, so I prefer to focus on treating the comorbidities

24

23.1%

c) There are few economic incentives in promoting public health/obesity prevention, and it is difficult charging fees for suggesting simple changes in diet and exercise routines

4

3.8%

d) It is my duty to discuss weight issues with the patient, but long-term follow-up and frequent consultations are beyond my capacity in busy practice

20

19.2%

e) I believe that most patients with obesity live in denial, and few methods are effective in maintaining weight, so I give them general advice and move on

27

26.0%

17. Choose the statement you agree the most with regarding your role as a medical professional who treats patients with obesity.

a) I trust my acquired knowledge from university education, and I know how to treat this patient

27

26.0%

b) I prefer to refer the patient to tertiary care/specialist health care services because I suggest that obesity is a self-inflicted condition and it is beyond my reach to treat

26

25.0%

c) I can handle treating the medical aspects of comorbidities, but not the complexity of the lifestyle issues

11

10.6%

d) I fear that I may create poor doctor-patient dynamics by bringing up weight and lifestyle issues. The subject of body weight is such a sensitive topic, and discussing it may make the patient reluctant to keep me as their GP

40

38.5%

Table 2: Physicians’ insight into obesity.

Physicians’ role

  Regarding physicians' role as medical professionals who treat patients with obesity, around 38.5% of physicians fear that they may create low doctor-patient dynamics by bringing up weight and lifestyle issues. Bodyweight is such a sensitive topic, and discussing it may make the patient reluctant to keep them as their GP. However, 26.0% trust their acquired knowledge from university education and know how to treat this patient. While 25.0% of them prefer to refer the patient to tertiary care/specialist health care services because they suggest that obesity is a self-inflicted condition and beyond their reach to treat, only 10.6% of physicians reported that they could handle treating the medical aspects of comorbidities, but not the complexity of the lifestyle issues, table 2.

Patients’ arm Demographics

  Patients are from Kuwait (23.4%), Bahrain (24.3%), Qatar (26.2%) and Oman (26.0%). The majority of them (70.1%) are local. Most (82.1%) of the 2337 enrolled patients belong to 25-44 years. Almost half of them were male (50.7%). The majority, 75.1%, are obese (BMI 30-35), and the rest, 24.91%, are very obese (BMI > 35). Almost 47.5% of them have hypertension, 37.7% diabetes, 35.0% arthritis and 28.3% have high cholesterol / lipids. More than 60% of them have the last visit to their physician during the past three months, table 3.

N

%

Sample size

2337

Country

Kuwait

548

23.4%

Bahrain

569

24.3%

Qatar

613

26.2%

Oman

607

26.0%

Nationality

Local

1639

70.1%

Expat Arabs

497

21.3%

Asians

155

6.6%

Westerners

46

2.0%

Age

18-24

98

4.2%

25-31

551

23.6%

32-37

738

31.6%

38-44

629

26.9%

45-51

172

7.4%

52-57

105

4.5%

58-62

22

0.9%

62+

22

0.9%

Gender

Male

1185

50.7%

Female

1152

49.3%

BMI

30-35

1755

75.1%

> 35

582

24.9%

Last visit

Past month

900

38.5%

Past 3 months

662

28.3%

Past 6 months

490

21.0%

Past year

204

8.7%

Do not remember

81

3.5%

Other conditions

Hypertension

1109

47.5%

Diabetes

881

37.7%

Arthritis

818

35.0%

High cholesterol / lipids

661

28.3%

Heart disease

483

20.7%

Chronic kidney disease

145

6.2%

Cancer

105

4.5%

Others

347

14.8%

Table 3: Patients’ demographic and clinical data.

Patients’ insight into obesity

  More than 60% of them mentioned that obesity has a significant impact on their lifestyle. About 71% reported that physical health had been impacted by obesity, and 67.0% mentioned that social life had been limited due to obesity. In addition, 82.0% see that romantic relationships have been limited because of obesity. Overall, 64.0% of reported that obesity has a significant effect on overall health.

  More than half the patients reported that being obese increases the risk of developing arthritis, heart disease, fatty liver, hypertension, and kidney failure. In addition, more than half the patients think that heart diseases, hypertension, sleep apnea, diabetes, cerebral stroke, arthritis, kidney failure, and severe depression are the most significant outcomes of being overweight or obese, table 4.

 

N

%

Sample size

2337

 

1. To what extent does Obesity affect your lifestyle?

 No effect

327

14.0%

 Small effect

538

23.0%

 Medium effect

701

30.0%

 Some times

304

13.0%

 All the time

467

20.0%

2. Has your physical health been impacted by Obesity? (yes)

1659

71.0%

3. Has your social life been limited due to obesity? (yes)

1566

67.0%

4. Have your romantic relationships been limited because of obesity? (yes)

1916

82.0%

5. To the best of your knowledge, does being obese increase a person’s risk of developing each of the following or does not increase that risk?

Heart disease

1332

57.0%

Hypertension

1239

53.0%

Sleep apnea

748

32.0%

Diabetes

1145

49.0%

Cerebral stroke

631

27.0%

Arthritis

1472

63.0%

Kidney failure

1169

50.0%

Severe depression

982

42.0%

Infertility in females

397

17.0%

Fatty liver

1285

55.0%

6. What do you think the most significant outcomes of being overweight or obese?

Heart disease

1309

56.0%

Hypertension

1285

55.0%

Sleep apnea

1332

57.0%

Diabetes

1192

51.0%

Cerebral stroke

1355

58.0%

Arthritis

1356

58.0%

Kidney failure

1308

56.0%

Severe depression

1285

55.0%

Others

1215

52.0%

7. Which statement comes closest to your view of obesity, even if neither is exactly right?

Obesity is a lifestyle choice resulting from a persons’ eating and exercise habits

1823

78.0%

Obesity is a disease resulting from many different genetic, environmental, and social factors

514

22.0%

8. Which statement comes closest to your view of obesity, even if neither is exactly right?

Obesity itself is a disease

958

41.0%

Obesity is a risk factor for other diseases, but it is not a disease itself

1379

59.0%

9. Which physician specialty/ HCPS do you see?

   

GP

491

21.0%

Family medicine

701

30.0%

Endocrinologist

631

27.0%

Obesity surgeon

280

12.0%

Health educator

374

16.0%

Dietitian

841

36.0%

Other

238

10.2%

10. To the best of your knowledge, how much obesity affects a person’s overall health?

Big effect

1496

64.0%

Small effect

841

36.0%

11. What is the role of physicians in education?

Have you ever told by a physician that you are obese? (Yes)

888

38.0%

Has your doctor ever initiated talk about your weight before? (Yes)

701

30.0%

Have you spoken with a doctor or health professional specifically about your weight? (Yes)

818

35.0%

12. How serious each of these health issues? average

 

Obesity/overweight

28.0%

 

Diabetes

59.0%

 

Mental illness

62.0%

 

Heart disease

81.0%

 

Cancer

95.0%

 

13. How do you perceive obesity?

   

Cosmetic issue

1472

63.0%

Serious health issue

865

37.0%

14. What is your worst fearful complication to have from obesity? % With from the below related to obesity:

Heart disease

1659

71.0%

Hypertension

351

15.0%

Sleep apnea

210

9.0%

Diabetes

1402

60.0%

Cerebral stroke

397

17.0%

Arthritis

1192

51.0%

Renal failure

280

12.0%

Other

491

21.0%

15. Is each of the following a major barrier, a minor barrier, or not a barrier at all to your attempts to lose weight?

Lack of power

1776

76.0%

I do not get enough support

1916

82.0%

Healthy foods are not convenient, affordable, or available enough

1612

69.0%

Unhealthy foods are too convenient, affordable, or available

1870

80.0%

There are not enough safe or low-cost options where I can be physically active

1986

85.0%

I spend too much time in front of TV, video games, or computer screens

1542

66.0%

I am generally predisposed to be overweight or obese

1336

57.2%

I do not have enough information to know how to manage my weight

2103

90.0%

Methods for losing weight are too expensive

1916

82.0%

Methods for losing weight are not covered by my health insurance

2150

92.0%

16. Please check all methods you are currently using or have tried to use in the past to lose weight

Losing weight on your own through diet and exercise

1753

75.0%

Losing weight with the help of your doctor through diet or exercise

1402

60.0%

One-on-one dietary counselling with a dietician

818

35.0%

Formal exercise programs with a personal trainer, physical therapist, or occupational therapist

514

22.0%

Formal weight loss programs such as Weight Watchers, Jenny Craig, Nutrisystem, LA Weight Loss, or a hospital-based program

677

29.0%

Dietary supplements such as Herbal-life

1542

66.0%

Prescription medication

1823

78.0%

Meal replacement

1402

60.0%

Weight loss surgery such as gastric bypass or gastric sleeve surgery

280

12.0%

Other treatments or methods such as online support groups

210

9.0%

Table 4: Patients’ insights into obesity.

  About 78.0% of patients view that obesity is a lifestyle choice resulting from a persons’ eating and exercise habits. More than half of the patients (59.0%) obesity is a risk factor for other diseases, but it is not a disease itself, while the rest (41.0%) see it as a disease itself.

  More than the third of patients (36.0%) see the dietitian, and 30.0% see the family physician. About the third of patients or more have ever been told by a physician that they are obese, their doctor has initiated a talk about weight before, and have spoken with a doctor or health professional about their weight, table 4.

  Patients perceived that obesity/overweight is less serious, with an average seriousness of 28.0% on a scale from 30 to 100%. About 63.0% perceived that obesity is a cosmetic issue and 37.0% see it as a serious health issue. The worst fearful complication from obesity is heart disease (71.0%), followed by diabetes (60.0%) and arthritis (51.0%), table 4.

  About 92.0% of patients reported that losing weight methods are not covered by their health insurance as a significant barrier to their attempts to lose weight, followed by a lack of information to manage weight (90.0%). Other barriers are shown in table 4.

  The most frequent methods that patients are currently using or have tried to use in the past to lose weight are prescription medication (78.0%), losing weight on their own through diet and exercise (75.0%), and dietary supplements such as Herbal-life (66.0%), table 4.

Discussion

  The double-arms cross-sectional study was established to improve the understanding of physicians and obese patients' perception and awareness with regards to risks, impacts, and management of obesity. The study was carried out in the Gulf countries Kuwait, Bahrain, Qatar, and Oman.

  The most frequent main modifiable reason for the increase in overweight and obesity, according to physicians, is the lack of self-control. Reduction in motivation and lack of compliance is the most likely contributors to weight gain after a period of weight loss. More than half of the enrolled physicians reported that BMI represents the current standard diagnostic criterion regarding obesity. Also, physicians see that 10-15 kg weight loss or 5-10% weight loss from baseline weight gives significant health improvements in terms of reducing body weight. In terms of treatment for obesity, 87.5% of physicians most likely prioritize those obese cases with comorbid conditions like diabetes, obstructive sleep apnea, hypertension, knee and low back pain. The most optimal lifestyle treatment strategy for obesity is diet, exercise, and CBT, followed by changing dietary habits. A low carbohydrate-high fat diet is the most effective one when considering long-term weight reduction. When looking at the conservative treatment of obesity, a diet very low in energy (<300 kcal/day) is the most appropriate recommendation.

  The most frequent recommended level of physical activity to maintain weight loss is 30 min/day moderate intensity followed by 45-60 min/day moderate intensity. On average, most physicians reported that 20% of individuals who have lost weight through lifestyle changes could maintain a clinically significant weight loss for at least one year. Exercising at high intensity > 3 times/week is most associated with long-term weight loss maintenance. Besides, when looking at long-term outcomes of surgical treatment of obesity (Gastric ByPass, GHPJ), physicians reported that patients who undergo GBP respond well when looking at WI. Low levels of vitamin B12, vitamin D, calcium, and iron, in addition to osteoporosis, are the most common complication after GBP.

  The results of this study showed that not all physicians believe that they have a responsibility to contribute to their patient’s successful weight loss efforts actively. The greater part of the physicians was not aware of their role to educate people with obesity. Physicians believe that busy practice, short time of consultation, and disease complexity are the main barriers to treating obesity. Health care providers should emphasize increasing the patients' awareness about their disease and involve them in making decisions regarding their treatment choices.

  More than half of the physicians think that community, focused group and public awareness and educational programs tailored to people with obesity help weight management. However, more than 70% of physicians claim that patient-focused training and education during the first year of their obesity management is essential. Therefore, awareness campaigns and strong partnerships are necessary to help improving disease awareness. Partnerships with patient groups, hospitals, and health associations to increase awareness of complications of obesity are necessary. Support local community partners to run screening, awareness, and counseling programs to empower people to safeguard and manage their health.

  From the obese patients’ perspective, more than half of them mentioned that obesity impacts their lifestyle, physical health, social life, and romantic relationships. Obesity has a significant effect on their overall health. More than half the patients reported that being obese increases the risk of developing significant outcomes like arthritis, heart disease, fatty liver, hypertension, and kidney failure. The majority of patients view that obesity is a lifestyle choice resulting from a persons’ eating and exercise habits.

About 41.0% of the patients see that obesity is a disease itself. About a third of patients see a dietitian or family physician for their obesity.

  On the other hand, physicians are reluctant to initiated talk about weight with patients. Patients perceived that obesity/overweight is less serious. They found it as a cosmetic issue. The worst fearful complication from obesity is heart disease, followed by diabetes and arthritis. Financial issues are significant barriers to attempts to lose weight, followed by lack of information. Prescription medications are the most frequent methods that patients are currently using or have tried to use in the past to lose weight, followed by diet and exercise and dietary supplements.

  On the other hand, around 28% of patients believe they are incredibly knowledgeable about obesity. While there is a stated acknowledgment that stroke and heart disease are serious diseases, a small portion of patients recognizes a link between them and obesity. Patients’ worst fear is quite distributed. Although patients with obesity see that stroke, heart diseases, and attacks are very serious; they rarely relate them to obesity. The majority of patients suffer from comorbidities like obesity and hypertension and do not necessarily have a balanced diet, thus not perceiving themselves as having a healthy lifestyle. There is a gap when it comes to obesity awareness and causes of obesity. Further awareness needs to be spread regarding the necessity of a healthy lifestyle for patients with obesity and the consequences of not doing so. Many patients admit that not being knowledgeable about obesity highlights the value a patient awareness campaign will provide.

  Patients mostly mention heart diseases, sleep apnea, and arthritis as the main consequences of obesity on the total level. However, when looking at those who see themselves as high-risk patients, higher mentions of heart diseases can be observed. Patients’ worst fear of obesity is quite different, and some are afraid of death, whereas others are worried about Diabetes and Hypertension. Clearer guidance is needed to know health issues associated with obesity, enabling people to more readily associate it with heart diseases and other complications. More effective and relevant channeling is needed to communicate heart diseases related events.

  When it comes to the perceived seriousness of obesity, most patients do not see it as a serious disease itself. However, when looking at CV diseases like stroke, heart attack, and heart disease, patients consider them significantly more serious. Heart diseases are not yet identified as a health issue associated with obesity. A link needs to be made between obesity and heart diseases. Patient awareness programs will increase awareness and, in turn, the perception of the seriousness of obesity. Patients perceive diabetes to be more serious than obesity confirms that increasing public awareness about a specific disease alters their perception.

Figure 1: Patients’ perception of obesity seriousness.

Conclusions

  Doctors have an essential role to play in educating patients on different risks associated with obesity, where patients who have had this discussion with their physicians are the ones who are aware of the risk. Patients do not fully understand the seriousness of the risks associated with obesity. Doctors need to be encouraged to treat obesity and educate their patients on the associated risk. The language used should reflect the seriousness of the risk associated with obesity to ensure that patients acknowledge and relate this risk to themselves. A campaign needs to use the physician-patient relationship, specifically GPs and family medicine, who see most patients.

Disclaimer

  This Publication is financially funded by Novo Nordisk. The authors take full responsibility for the content and conclusions stated in this manuscript. Novo Nordisk neither influenced the content of this publication nor was it involved in the data collection, analysis, interpretation or review.

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Copyright: © 2021 Salman K Al-Sabah., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



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