Citerank: (46) 348686Improve support for people with severe and complicated obesityGreater focus needs to be devoted to strategies supporting individuals who are already obese. Current government policy is focused largely on prevention, which is vital in ensuring the scale of the obesity problem and its associated costs do not increase. It does not, however, address the problems of those people already obese or morbidly obese and the costs associated with their health conditions. Moreover, obesity treatment is often cost effective.109FDEF6, 3523581 in 5 UK children aged 10-11 are obeseThe National Child Measurement Programme (NCMP) figures for 2013/14, show that 19.1% of children in Year 6 (aged 10-11) were obese and a further 14.4% were overweight. Obese children and adolescents are at an increased risk of developing various health problems—such as asthma, cardiovascular disease and type 2 diabetes (as well as low self-esteem and depression)—and are also more likely to become obese adults.648CC79C, 352454What is obesity?Obesity is a medical condition in which excess body fat has accumulated to the extent that it may result in increased health problems and reduced life expectancy. As central obesity (excess ectopic fat stored around major organs and abdomen) is the most dangerous form to health, waist measurement can be a key indicator of risk. Generally, men with a waist circumference of 94cm or more (and women of 80cm or more) are more likely to develop obesity-related health problems.82AECCD8, 352559Weight management services in the UK are poorly developedAlthough the prevalence of obesity in adults and in children in the UK is amongst the highest in the developed world, the multidisciplinary services necessary to manage patients with an established problem of excess weight and its clinical consequences are poorly developed within the UK. Some prevention and intervention strategies are provided in primary care, but secondary care and specialist services remain underdeveloped or unavailable to meet the need.555CD992, 352560Existing training is inadequate and ineffectiveTraditional methods of training for healthcare professionals are inadequate and ineffective with respect to obesity.1198CE71, 352562Multidisciplinary teams to cover severe and complex obesity across UKCommissioning of specialist obesity services should be for multidisciplinary care of ‘severe and complex obesity’ and not directly for rather than just bariatric surgical treatment. Need multidisciplinary teams (MDTs) available to cover severe and complex obesity throughout the UK.109FDEF6, 352563Increase investment in obesity research565CA4D9, 352564Every local authority should have an obesity champion565CA4D9, 352565Better weight management resources for obese healthcare workersBetter weight management resources for healthcare workers who have an obesity problem.565CA4D9, 352566Set up a specialist group of bariatric nursesThe Royal College of Physicians in conjunction with the Royal College of Nursing should up a specialist group of bariatric nurses who are trained in the specialist aspects of bariatric medicine and surgery, including post-surgery follow-up.565CA4D9, 352569Develop a patient charter for those with obesity problems109FDEF6, 352570Undertake a systematic review of specialist obesity servicesUndertake a systematic review of specialist obesity services between the Royal College of General Practitioners community leads and the Royal College of Physicians (RCP) and learned societies, including the Society for Endocrinology, Diabetes UK and the Association of British Clinical Diabetologists565CA4D9, 352589RCP oversee the development of multidisciplinary bariatric servicesThe Royal College of Physicians (RCP) should oversee the development of multidisciplinary bariatric services to cover the population in the UK.109FDEF6, 352590RCP should provide courses to train doctors in MDT formationThe RCP should promote the provision of these multidisciplinary groups by developing and providing courses that advise, encourage and train doctors (and other healthcare professionals) on their formation.109FDEF6, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 352714Pharmacological treatment can be cost-effectiveA systematic review of pharmacological treatment in primary care (orlistat, sibutramine and rimonabant– the latter two now withdrawn) has shown all were effective at reducing weight and BMI, and cost effective when using a threshold of £20,000 per QALY. 1198CE71, 352716Bariatric surgery can be cost effectiveAnalysis by the Office of Health Economics estimated that between around 10,000 and 140,000 of patients could receive bariatric surgery based on the assumption of between 1% and 25% of patients eligible for surgery choosing to take this option. Overall the economic benefit ranged between £382m and £1,295m savings after three years to the NHS after surgery if 25% of patients potentially eligible for surgery chose this option.1198CE71, 352718Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 352913Royal College of PhysiciansIn addition to supporting physicians in their daily practice, our public health activities include campaigning for change, advising government and parliament, and taking part in national debates on medical, clinical and public health issues. The RCP has supported and represented physicians for nearly 500 years. Our roots stretch back to Henry VIII, but our 29,000 members today work in the fast-paced, ever-changing, highly technological world of medicine in the UK and across the globe.58D3ABAB, 362143Appoint an obesity champion or tsarAppoint a government obesity champion to drive a coordinated obesity strategy between and across central government departments which include Health, the Treasury, Sport, Education, Agriculture, the Department of Work and Pensions, and local government for the local environment. This person should have a strong but politically independent status (e.g. a member of the House of Lords) with the skills and authority to address issues which need multiple government departmental involvement.565CA4D9, 370327Understand the ten essential facts about obesityAll healthcare professionals should know and understand the ‘Ten essential facts about obesity’.109FDEF6, 371613Strong business case for investment in employee health and wellbeingInvesting in the health and wellbeing of employees makes business sense. It has been estimated that working age ill-health costs the UK £100 billion per annum, more than the annual budget for the NHS. In 2009–10, 23.4 million days were lost due to work-related ill-health.1198CE71, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399548Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399564Better weight management resources for obese healthcare workersBetter weight management resources for healthcare workers who have an obesity problem.565CA4D9, 399569Strong business case for investment in employee health and wellbeingInvesting in the health and wellbeing of employees makes business sense. It has been estimated that working age ill-health costs the UK £100 billion per annum, more than the annual budget for the NHS. In 2009–10, 23.4 million days were lost due to work-related ill-health.1198CE71, 399585Undertake a systematic review of specialist obesity servicesUndertake a systematic review of specialist obesity services between the Royal College of General Practitioners community leads and the Royal College of Physicians (RCP) and learned societies, including the Society for Endocrinology, Diabetes UK and the Association of British Clinical Diabetologists565CA4D9, 399593Increase investment in obesity research565CA4D9, 399605Existing training is inadequate and ineffectiveTraditional methods of training for healthcare professionals are inadequate and ineffective with respect to obesity.1198CE71, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399619Appoint an obesity champion or tsarAppoint a government obesity champion to drive a coordinated obesity strategy between and across central government departments which include Health, the Treasury, Sport, Education, Agriculture, the Department of Work and Pensions, and local government for the local environment. This person should have a strong but politically independent status (e.g. a member of the House of Lords) with the skills and authority to address issues which need multiple government departmental involvement.565CA4D9, 399699Set up a a specialist group of bariatric nursesThe Royal College of Physicians in conjunction with the Royal College of Nursing should up a specialist group of bariatric nurses who are trained in the specialist aspects of bariatric medicine and surgery, including post-surgery follow-up.565CA4D9, 399713Improve support for people with severe and complicated obesityGreater focus needs to be devoted to strategies supporting individuals who are already obese. Current government policy is focused largely on prevention, which is vital in ensuring the scale of the obesity problem and its associated costs do not increase. It does not, however, address the problems of those people already obese or morbidly obese and the costs associated with their health conditions. Moreover, obesity treatment is often cost effective.109FDEF6, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399742Every local authority should have an obesity champion565CA4D9, 399792Multidisciplinary teams to cover severe and complex obesity across UKCommissioning of specialist obesity services should be for multidisciplinary care of ‘severe and complex obesity’ and not directly for rather than just bariatric surgical treatment. Need multidisciplinary teams (MDTs) available to cover severe and complex obesity throughout the UK.109FDEF6, 399793Develop a patient charter for those with obesity problems109FDEF6, 399794Pharmacological treatment can be cost-effectiveA systematic review of pharmacological treatment in primary care (orlistat, sibutramine and rimonabant– the latter two now withdrawn) has shown all were effective at reducing weight and BMI, and cost effective when using a threshold of £20,000 per QALY. 1198CE71, 399795Bariatric surgery can be cost effectiveAnalysis by the Office of Health Economics estimated that between around 10,000 and 140,000 of patients could receive bariatric surgery based on the assumption of between 1% and 25% of patients eligible for surgery choosing to take this option. Overall the economic benefit ranged between £382m and £1,295m savings after three years to the NHS after surgery if 25% of patients potentially eligible for surgery chose this option.1198CE71, 399833Understand the ten essential facts about obesityAll healthcare professionals should know and understand the ‘Ten essential facts about obesity’.109FDEF6, 399859RCP oversee the development of multidisciplinary bariatric servicesThe Royal College of Physicians (RCP) should oversee the development of multidisciplinary bariatric services to cover the population in the UK.109FDEF6, 399860RCP should provide courses to train doctors in MDT formationThe RCP should promote the provision of these multidisciplinary groups by developing and providing courses that advise, encourage and train doctors (and other healthcare professionals) on their formation.109FDEF6, 399892What is obesity?Obesity is a medical condition in which excess body fat has accumulated to the extent that it may result in increased health problems and reduced life expectancy. As central obesity (excess ectopic fat stored around major organs and abdomen) is the most dangerous form to health, waist measurement can be a key indicator of risk. Generally, men with a waist circumference of 94cm or more (and women of 80cm or more) are more likely to develop obesity-related health problems.82AECCD8, 399931Weight management services in the UK are poorly developedAlthough the prevalence of obesity in adults and in children in the UK is amongst the highest in the developed world, the multidisciplinary services necessary to manage patients with an established problem of excess weight and its clinical consequences are poorly developed within the UK. Some prevention and intervention strategies are provided in primary care, but secondary care and specialist services remain underdeveloped or unavailable to meet the need.555CD992, 3999751 in 5 UK children aged 10-11 are obeseThe National Child Measurement Programme (NCMP) figures for 2013/14, show that 19.1% of children in Year 6 (aged 10-11) were obese and a further 14.4% were overweight. Obese children and adolescents are at an increased risk of developing various health problems—such as asthma, cardiovascular disease and type 2 diabetes (as well as low self-esteem and depression)—and are also more likely to become obese adults.648CC79C

Citerank: (37) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348677Implement hard hitting campaigns, similar to those for anti-smokingHarder hitting campaigns, similar to those for anti-smoking, are required.1198CE71, 348678Incentivise GPs to improve patient outcomesThe Quality and Outcomes Framework should be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients. [1]565CA4D9, 348679Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 348680Need to make every contact with patients countGPs and other health professionals should be encouraged and required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances. [1]109FDEF6, 348684Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 348685Better hydrationGovernment initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes.565CA4D9, 348687More physical activity for kids within and beyond educational settingsThe introduction of compulsory physical education in schools is positive. However, greater promotion of physical activity outside of educational settings is also key to ensure any participation amongst pupils is not limited to school. Similarly, caution is needed to ensure that the promotion of competitive sport does not put off children less disposed to that sport. This could result in children either returning to or increasing their sedentary lifestyle.565CA4D9, 348688Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 24.9% of adults in England are obese—with a body mass index of over 30—62% of adults are either overweight or obese (with a BMI of over 25), and 32% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK is estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 348689Encourage physical activity in daily lifeThe Chief Medical Officer’s report (2011) recommends that adults aged 19-64 years undertake 150 minutes of moderate intensity physical activity per week in bouts of 10 minutes or more. [1]565CA4D9, 348695The Quality and Outcomes FrameworkThe QOF was introduced in 2004 as a voluntary incentive scheme for GP practices in the UK. It contains groups of indicators against which practices score points according to their level of achievement, with a higher score leading to higher financial rewards. The aim of the QOF is to highlight priorities for improving patient care and provide incentives for GPs to drive up quality in these areas.82AECCD8, 348704GPs should measure waist circumferenceGPs should measure waist circumference rather than just BMI to help them identify patients who are most at risk and identify the indicators of poor health outcomes. [1]109FDEF6, 348706National Obesity ForumThe National Obesity Forum (NOF) was established in May 2000 to raise awareness of the emerging epidemic of obesity and the effect that it was going to have on both individuals and the NHS.58D3ABAB, 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 366828Shape the physical environment to encourage physical activity565CA4D9, 371560British Heart Foundation recommends at least 60 minutes every dayThe British Heart Foundation recommends that to maintain their health, children take part in a minimum of 60 minutes of at least moderate intensity physical activity every day. This could include PE lessons, but also swimming, dancing, cycling, most other sports and brisk walking, as well as active play. 1198CE71, 371561Quality and prevalence of physical activity in schools is variableThe Ofsted Physical Education report published in February 2013 found that the physical aspect of physical education was not doing enough to tackle sedentary lifestyles amongst children and young people, with teachers often spending too much time talking and not enough time getting children moving.1198CE71, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399553Shape the physical environment to encourage physical activity565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399584Incentivise GPs to improve patient outcomesThe Quality and Outcomes Framework should be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients. [1]565CA4D9, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399642Implement hard hitting campaigns, similar to those for anti-smokingHarder hitting campaigns, similar to those for anti-smoking, are required.1198CE71, 399667Better hydrationGovernment initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes.565CA4D9, 399668Encourage physical activity in daily lifeBuild exercise into daily life to promote energy balance. Adults are recommended to take part in 150 minutes of moderate intensity activity every week.565CA4D9, 399695Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399737Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 399768More physical activity for kids within and beyond educational settingsThe introduction of compulsory physical education in schools is positive. However, greater promotion of physical activity outside of educational settings is also key to ensure any participation amongst pupils is not limited to school. Similarly, caution is needed to ensure that the promotion of competitive sport does not put off children less disposed to that sport. This could result in children either returning to or increasing their sedentary lifestyle.565CA4D9, 399787The Quality and Outcomes FrameworkThe QOF was introduced in 2004 as a voluntary incentive scheme for GP practices in the UK. It contains groups of indicators against which practices score points according to their level of achievement, with a higher score leading to higher financial rewards. The aim of the QOF is to highlight priorities for improving patient care and provide incentives for GPs to drive up quality in these areas.82AECCD8, 399831Need to make every contact with patients countGPs and other health professionals should be encouraged and required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances. [1]109FDEF6, 399832GPs should measure waist circumferenceGPs should measure waist circumference rather than just BMI to help them identify patients who are most at risk and identify the indicators of poor health outcomes. [1]109FDEF6, 399840British Heart Foundation recommends at least 60 minutes every dayThe British Heart Foundation recommends that to maintain their health, children take part in a minimum of 60 minutes of at least moderate intensity physical activity every day. This could include PE lessons, but also swimming, dancing, cycling, most other sports and brisk walking, as well as active play. 1198CE71, 399841Quality and prevalence of physical activity in schools is variableThe Ofsted Physical Education report published in February 2013 found that the physical aspect of physical education was not doing enough to tackle sedentary lifestyles amongst children and young people,with teachers often spending too much time talking and not enough time getting children moving.1198CE71, 399972Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 23% of adults are obese—with a body mass index of over 30—61% of adults are either overweight or obese (with a BMI of over 25), and 33% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK economy has been estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179

Citerank: (7) 348684Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399737Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6

Citerank: (7) 381550Knowledge gaps on obesity guidelinesA US study [1] designed to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity found that respondents demonstrated knowledge gaps on obesity guidelines.1198CE71, 381551Knowledge gaps on pathophysiology A US study [1] designed to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity found that respondents demonstrated knowledge gaps on pathophysiology.1198CE71, 381552Lack of understanding of obesity medication efficacy and safetyA US study [1] designed to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity found that respondents generally lacked understanding of obesity medication efficacy, safety and MOA.1198CE71, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399828Knowledge gaps on obesity guidelinesA US study [1] designed to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity found that respondents demonstrated knowledge gaps on obesity guidelines.1198CE71, 399829Knowledge gaps on pathophysiology A US study [1] designed to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity found that respondents demonstrated knowledge gaps on pathophysiology.1198CE71, 399830Lack of understanding of obesity medication efficacy and safetyA US study [1] designed to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity found that respondents generally lacked understanding of obesity medication efficacy, safety and MOA.1198CE71

> Objective: Approximately 35% of US adults are obese. The purpose of this study was to assess the knowledge and practice patterns of primary care physicians (PCPs), endocrinologists (ENDOs), cardiologists (CARDs) and bariatricians (BARIs) regarding obesity.

> Methods: A case vignette survey was distributed to 1625 US-based PCPs, ENDOs, CARDs, and BARIs via email and fax in February 2013. Results were analysed with PASW Statistics 18.

> Results: Respondents included 100 PCPs, 100 ENDOs, 70 CARDs, and 30 BARIs. The majority agreed obesity is a disease as defined by the AMA, however, half of PCPs, ENDOs, and CARDs also agreed obesity results from a lack of self-control. Familiarity with select obesity guidelines was low. Nearly all respondents used body mass index for obesity screening. No consensus as to when to initiate weight-loss medication was observed. Many physicians expected a larger weight loss with pharmacotherapy than is realistic (∼30%) or were unsure (∼22%). A majority of PCPs, ENDOs and CARDs expected less excess weight loss with gastric bypass surgery than is realistic, BARIs had a more reasonable expectation.

> Conclusions: Overall, respondents demonstrated knowledge gaps for obesity guidelines and pathophysiology and generally lacked understanding of obesity medication efficacy, safety and MOA.

Many clinicians are not adequately aware of the reasons that individuals with obesity struggle to achieve and maintain weight loss, and this poor awareness precludes the provision of effective intervention. Irrespective of starting weight, caloric restriction triggers several biological adaptations designed to prevent starvation. These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification in most individuals with obesity, particularly in an environment that promotes energy overconsumption.