San Antonio — New research reveals significant gaps in knowledge among primary care providers regarding effective obesity management, despite the critical prevalence of obesity within this medical setting.
Anonymous surveys conducted among 96 primary care providers at a safety-net hospital in Boston, Massachusetts, demonstrated that many participants struggled with the criteria for prescribing antiobesity medications (AOM) and expressed discomfort with their ability to prescribe AOMs, particularly for medications outside of the non–glucagon-like peptide 1 (GLP-1) receptor agonists category. Notably, one-third of respondents indicated they preferred not to prescribe AOMs, and there was a similarly low rate of referrals for bariatric surgery.
The compelling findings were presented at the Obesity Society’s annual meeting, known as Obesity Week, by Alejandro Campos, MD, a third-year resident in the internal medicine department at Boston Medical Center and Boston University. Campos emphasized the need for a stronger educational foundation on obesity management among healthcare providers.
“I think it comes down to education… Not only training primary care physicians or residents about criteria and pathophysiology, but also stigma,” Campos shared during an interview with Medscape Medical News. “Perceptions need to be addressed from the start of training in the healthcare field.”
This study marks a pioneering effort to examine such knowledge deficits in a safety-net hospital environment, which often serves low-income individuals facing disproportionately high obesity rates. Campos noted, “These findings are similar to ones observed from non–safety-net settings, which can indicate some potential transferability.”
Session moderator John D. Clark, MD, PhD, Chief Population Health Officer at Sharp Rees-Stealy Medical Group in San Diego, California, expressed that the findings resonated with his expectations. “I’d say that medical education around obesity has definitely improved, and training is improving but it’s not uniform. The treatment of obesity as a disease, especially with some of the newer medical treatments, is not standard of care and practiced widely.”
To assess provider knowledge, a comprehensive Knowledge, Attitudes, and Practices questionnaire was developed and distributed electronically for anonymous responses from both trained providers and those in training. This survey consisted of 43 items covering demographic information, knowledge, attitudes, and practical applications.
The hospital is notably the largest safety-net hospital in New England, catering to a diverse patient population, including 58% enrolled in Medicaid, with significant representation from Black/African American (32%) and Hispanic/Latino (24%) communities, and 37% of patients living below the poverty line.
Among the 96 responding healthcare providers—out of 350 invited—participants worked predominantly in family medicine or internal medicine, including a mix of attending MDs and nurse practitioners, as well as residents in training. Interestingly, two-thirds of the participants were women. The majority were 20-30 years old (49.45%) or between 31-40 years old (27.47%).
Significantly, 73.63% of providers reported receiving some form of obesity-related training, with slightly over half (52.08%) receiving this training during their medical or nursing education, while 43.75% acquired it during their residency training.
Survey respondents largely recognized benefits associated with a 10% reduction in body weight, noting positive impacts on conditions such as obstructive sleep apnea (OSA), glycemia, cardiovascular disease risk, osteoarthritis, and hepatic steatosis. However, only about half were aware that weight loss could also alleviate urinary incontinence.
Alarmingly, just 25% could accurately identify both indications for AOMs. Only 27.1% understood that one indication is a BMI ≥27 with comorbidities, while 46.9% recognized that a BMI ≥30 without comorbidities is valid for AOM prescription. A mere 9.4% were accurate in identifying both indications for bariatric surgery.
When it came to prescribing AOMs, 73% of trained providers and 59% of those in training indicated they do so regularly. Notably, providers expressed significantly greater comfort when prescribing newer medications such as semaglutide and liraglutide, compared to older options like bupropion/naltrexone and phentermine/topiramate.
The survey revealed that factors influencing comfort in prescribing AOMs included knowledge of side effects, insurance coverage, safety concerns, and dosing information. Less frequently cited were patient-related factors, such as their ideas, concerns, and expectations, alongside cost and efficacy of treatments.
Interestingly, referrals for nutrition services were preferred over referrals to obesity medicine specialists or for bariatric surgery.
When questioned about barriers to effective obesity treatment in their practices, providers most often cited “time constraints,” followed by “lack of training or knowledge,” “patient adherence and motivation,” and “limited resources.”
Looking ahead, Campos stated, “What are the future directives? We feel we have the need to provide ongoing obesity management, education and assistance to primary care providers, including support for securing coverage for treatments.”
Furthermore, he mentioned that Boston Medical Center is developing and implementing an embedded weight management program within primary care settings “to assist the front line of obesity care.”
When asked about the potential impact of GLP-1 drugs on obesity treatment, Campos confidently asserted, “Definitely, I think with that momentum obesity medicine as a whole will gain more attention, and hopefully more implementation in the curricula for medical and nursing schools, because in the end it requires a multidisciplinary approach.”
Campos and Clark had no disclosures.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape Medical News and her work has also appeared in major outlets like the Washington Post, NPR’s Shots blog, and Diatribe. Follow her on X @MiriamETucker.
**Interview with Dr. Alejandro Campos on Obesity Management in Primary Care**
**Interviewer:** Good afternoon, Dr. Campos. Thank you for joining us today. Your recent study presented at Obesity Week highlights some concerning gaps in knowledge among primary care providers regarding obesity management. Can you tell us more about what you discovered?
**Dr. Campos:** Thank you for having me. Yes, our research surveyed 96 primary care providers at a safety-net hospital in Boston, and we found that many providers struggled to understand the criteria for prescribing antiobesity medications. In fact, about one-third of them preferred not to prescribe these medications at all, and there was a very low rate of referrals for bariatric surgery.
**Interviewer:** That’s quite alarming. What do you think is contributing to this lack of knowledge and comfort among healthcare providers?
**Dr. Campos:** I believe it fundamentally comes down to education. While there’s been progress in medical training regarding obesity, it is not consistent across the board. It’s essential not only to teach the clinical aspects—like the criteria and pathophysiology of obesity—but also to address the stigma surrounding it. These perceptions need to be addressed early in medical training.
**Interviewer:** You noted that your findings resonate with those from non-safety-net settings. How does this impact the management of obesity among low-income populations?
**Dr. Campos:** This suggests that the knowledge gaps are widespread and not limited to just safety-net hospitals. Low-income individuals often face the highest rates of obesity, and if providers lack the necessary training to manage this condition effectively, those patients may not receive the care they need. This can perpetuate health inequalities.
**Interviewer:** Can you elaborate on the response rates and demographics of the providers in your study?
**Dr. Campos:** Certainly. Out of 350 invited, we received responses from 96 providers, including a significant number from family medicine and internal medicine. Notably, two-thirds were women, and many were young, between 20 and 40 years old. Interestingly, around 74% reported receiving some obesity-related training, mostly during medical school or residency.
**Interviewer:** That’s an important demographic to consider. What did the providers recognize as the benefits of weight loss, and where were the knowledge gaps?
**Dr. Campos:** Most providers understood that a 10% reduction in body weight could positively impact various health conditions, such as obstructive sleep apnea and cardiovascular risks. However, only about 50% recognized that weight loss could alleviate urinary incontinence, which indicates a significant gap in awareness.
**Interviewer:** Lastly, how does the comfort level with prescribing different classes of AOMs vary among providers?
**Dr. Campos:** Our findings showed that while a majority of providers felt comfortable prescribing newer medications like semaglutide, there was less comfort with older options such as bupropion/naltrexone. This disparity suggests a need for more targeted training around all antiobesity medications to ensure providers feel equipped to treat their patients.
**Interviewer:** Thank you, Dr. Campos, for sharing these insights. It’s clear that addressing these educational gaps is crucial for effective obesity management in primary care.
**Dr. Campos:** Thank you for having me. I hope our research sparks further discussion and action towards improving education around obesity in healthcare.