Medical nutrition therapy and physical activity are often used exclusively for obesity treatment despite the availability of effective adjunctive interventions, including psychological intervention, pharmacological therapy, and bariatric surgery. We conducted a qualitative study through interviews with people living with obesity (PwO) and general/family practitioners (GP/FPs) to better understand the factors contributing to healthcare decision-making and therapeutic inertia in obesity management. Phone interviews were conducted by the same investigator using discussion guides informed by the Theoretical Domains Framework (TDF) . Eligibility criteria for PwO included having a BMI over 30 kg/m2.
A total of 20 PwO and 20 GP/FPs across Canada were interviewed with representation across gender and ethnicity. PwO also varied in obesity classification and experience with management strategies. GP/FPs varied in practice type, local community, and awareness of the 2020 Canadian Adult Obesity Clinical Practice Guidelines.
Themes related to therapeutic inertia mapped to all 14 TDF domains. Both PwO and GP/FPs often perceived obesity to be a secondary health priority that is associated with negative emotions, which had pervasive influence on obesity management. PwO were hesitant to explore new strategies due to financial barriers, access to support, and concerns of adverse side-effects, effectiveness, and sustainability of interventions that support eating and physical activity behavioral changes. GP/FPs were limited in time and resources, and were hesitant to recommend specific treatments due to concerns of risks, effectiveness, and accessibility. GP/FPs were also hesitant to make referrals due to skepticism of whether other healthcare providers can provide better care. Future research will validate these themes in a larger, national sample of PwO and GP/FPs to understand how individuals can overcome the therapeutic inertia.
D. C. Lau: Advisory Panel; Amgen Canada, Novartis Canada, Novo Nordisk Canada Inc., Board Member; Canadian Association of Bariatric Physicians and Surgeons, Consultant; Pfizer Inc., Viatris Inc., Research Support; Novo Nordisk Canada Inc., Speaker’s Bureau; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Canadian Collaborative Research Network, CME at Sea, Eli Lilly and Company, HLS Therapeutics Inc., Novo Nordisk Canada Inc., Obesity Canada. I. Patton: None. R. Lavji: Employee; Novo Nordisk Canada Inc., Stock/Shareholder; Moderna, Inc., Novo Nordisk, Pfizer Inc. A. Belloum: None. G. Ng: Other Relationship; Novo Nordisk Canada Inc. R. Modi: Advisory Panel; Bausch Health, Canada, Eli Lilly and Company, Novo Nordisk Canada Inc., Other Relationship; Takeda Canada.