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Maryam Taufeeq, MD – Fellow, The Ohio State University

Kyle Porter, MAS – Senior Statistician, The Ohio State University

Irina Haller, PhD – Research Scientist, Essentia Health

Kate Bauer, PhD – Assistant Proffessor, University of Michigan

Steven Bradley, MD – Cardiologist, Allina Health

Lila Rutten, PhD – Consultant, Mayo Clinic

Ivana Croghan, PhD – Associate Consultant II-Research, Mayo Clinic

David Bradley, MD – Assistant Proffessor, The Ohio State University


Objective : Over 70% of the adult US population is either overweight or obese, a condition that increases the risk of multiple complications. Despite these risks, very few studies have evaluated patients’ experiences and expectations for weight management with their primary care providers (PCP). We have previously shown that patients with higher BMI are more likely to avoid health care visits, feel judged by their PCP, and are less likely to want to discuss their weight in clinic visits. However, no studies have addressed the influence of economic stability and education (key social determinants of health that contribute to widespread health inequities) on these factors. Therefore, the primary aim of this study was to assess the impact of these factors on healthcare provider weight management advice and patient’s perception of this advice.

Methods : Through the Learning Health System Network (LHSNet), a total of 19,964 surveys were mailed to patients identified as overweight/obese at 5 health care systems across 11 states. Multivariable logistic regression controlling for age, BMI, ethnicity/race, and gender was used to evaluate factors associated with negative patient-health care provider interactions. Of the 2799 surveys, 305(10.9%) were excluded due to incomplete survey data and 155(5.5%) were excluded due to BMI<25. Among the 2339 respondents, 671(28.7%) were overweight, with the remainder classified as obese(27.5% obesity class I;20.9% class II,23.2% class III)

Results : Patients with lower annual income (<$50,000/year) reported that their PCP was less likely to have a current role in their weight management, and that they were less likely to be treated as an equal by their healthcare provider. Patients reporting lower levels of education (High School/GED or less and/or less than 4-year college degree) were also less likely to feel respected, believe that their PCP should have a role in their weight management, has a current role in their weight management, and spent enough time with them providing weight loss advice

Discussion : Several barriers exist between patients’ receiving obesity management per established guidelines, and among these are socioeconomic determinants of health. In this large survey of overweight and obese patients, we found that patients’ perceptions of their experiences and expectations regarding weight management differed according to their degree of economic stability and educational status, even when controlling for ethnicity/race

Conclusion : More resources need to be made available to eliminate these barriers, account for social determinants of health, and create a more productive healthcare environment to address the obesity epidemic

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