SEATTLE — Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults. But stigma and a belief that one is too heavy for treatment become more influential barriers the heavier a person is.
Little is known from the literature about patterns of treatment seeking for obesity over time, and little is known about barriers that might prevent treatment seeking from taking place, Anna C. Ciao, a graduate student at the University of Hawaii, Honolulu, said at an international conference sponsored by the Academy for Eating Disorders.
Ms. Ciao was reporting on an anonymous online survey offered to overweight or obese men and women aged 18 years or older in which the participants were asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.
They were also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.
Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, and 86% were women, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Their mean age was 30 years (range was 18–67 years), and their mean body mass index (BMI) was 33 kg/m
Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the future. In contrast, surgery was the least commonly sought, desired, and planned treatment; 8% of respondents had sought surgery, 18% desired it, and 8% planned to have it.
“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said, noting that 11% had not sought any of the treatments, 28% did not desire any, and 25% had no plans for any.
Of the five barriers to treatment, the most commonly cited overall was money and the second was not having enough time. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.
With the exception of surgery, the mean number of barriers cited for a treatment increased with intensity, ranging from 0.8 barriers for treatment on one's own to 1.3 barriers for medical doctors. The mean number for surgery was 0.5. Ms. Ciao said surgery might have been an outlier because individuals must qualify for this treatment, so they might have perceived the barriers as irrelevant.
BMI was correlated with the total number of treatments sought but not with the number desired or planned.
“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” a disconnect that might suggest “some discouragement from the failed weight-loss attempt,” she said.
BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment, she said. BMI was also correlated with stigma and being too heavy for treatment individually. “This is consistent with the literature that suggests that individuals are afraid of stigmatization, especially from professionals,” Ms. Ciao said. “Feeling too heavy may reflect an anticipated failure or expectation that weight-loss treatment may not work for them.”
Ms. Ciao reported she had no conflicts of interest in association with the study.