Public’s view of obesity has changed since the pandemic, survey shows

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 thought about turning to either weight-loss surgery or taking prescription anti-obesity drugs for the first time, according to a new survey whose findings were published online in the peer-reviewed journal, Surgery for Obesity and Related Diseases (SOARD).

Another nearly 1 in 5 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%).

The nationally representative public opinion survey of more than 1,700 adults was conducted by NORC at the University of Chicago, an independent research institution, 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 nonprofit dedicated to obesity research, education and advocacy, provided financial support for the survey.

According to the U.S. Centers for Disease Control and Prevention (CDC), obesity effects 42.4% of Americans. Studies show the disease can weaken or impair the body's immune system and cause chronic inflammation and increase the risk of many other diseases and conditions including cardiovascular disease, stroke, type 2 diabetes, certain cancers, and now COVID-19. Among 148,494 adults who received a COVID-19 diagnosis during an emergency department or inpatient visit at 238 U.S. hospitals between March and December 2020, nearly 30% had overweight and more than half (50.8%) had obesity.

"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 Shanu N. Kothari, MD, co-author of the study and immediate past president of the ASMBS, the nation's largest organization 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 survey 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.

Obesity as big a health threat as cancer but few go beyond diet and exercise alone

The survey found 8 in 10 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. When it does happen, it's more often initiated by the patient."

Jennifer Benz, PhD, Lead Researcher, Vice President, Public Affairs and Media Research at NORC

Disconnect between patients and doctors on obesity

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.

"Our hope is that people turn the fear of obesity and the consideration of new weight-loss strategies into action," said Teresa LaMasters, MD, 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."

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.