Mr Epidemiology

In countries where healthcare is funded by taxpayers, concerns over whether or not obesity treatment should be included under the umbrella of national healthcare is an ongoing concern. While this is also a concern in countries with private healthcare, in the public healthcare system the cost may be borne by society as a whole.

Perhaps the biggest issue in supporting obesity treatment programs is *not* whether or not there is a need for treatment: it’s obvious these people need help. The underlying issue is whether or not there is *public support* for treatment. Skim through the comments section on any CBC or Globe and Mail piece on obesity, and it is clear that this is a very contentious issue.

Prejudice and discrimination against the obese is not new, and last year the Canadian Obesity Network, along with partners, hosted the 1st Canadian Summit on Weight Bias and Discrimination (for more information, see the executive summary.) Knowing this prejudice exists, researchers in Denmark set out to investigate public support for obesity treatment, and to identify predictors of this support.

What did they do?

A representative sample of 3,696 Danish citizens was drawn from an existing database of approximately 120,000 people. Of these, 1,141 people filled out the survey (30.9%). Interestingly, this study did not require ethical approval in Denmark since the participants were anonymous to the researchers and there was no experimental component (the more you know!). Compared to the population, this sample underrepresented those with low education and low income, but was the same on geographic region and gender.

Via an internet-based questionnaire, they asked people their views on funding on five obesity-related measures: 1) weight loss surgery, 2) medical treatment, 3) psychological therapy, 4) dietary counseling and 5) informational campaigns. Participants were asked if they felt that each measure should be funded by the government, by the individual or don’t know. To assess obesity prejudice, they used two domains: dislike and perceived control. Dislike was further broken down into three scales: negative judgement, distance and attraction (see the paper for a full description of the methods).

What did they find?

Weight loss surgery and medical treatment were equally rated, with only 33.3% and 39.1% respectively believing that this should be funded by the public. In comparison, psychological therapy, dietary counseling and informational campaigns enjoyed much more support, 51.6%, 67.8% and 83.8% respectively. They found that negative judgement, distance and lack of attraction were all associated with disapproval of public funding, with negative judgement and distance no longer being significant when perceived control was included in the model.

And what now?

Their research highlights that while some forms of obesity treatment might not be viewed positively, there are some forms that do have a lot public support. For those who didn’t support obesity treatment, it was unclear whether this was due to a lack of understanding behind the complex causes of obesity, or other, unknown, issues. As acknowledged by the researchers however, if policymakers want to include obesity treatment in public healthcare, they will need to first understand where public resistance is coming from.

References
Lund TB, Sandøe P, & Lassen J (2011). Attitudes to publicly funded obesity treatment and prevention. Obesity (Silver Spring, Md.), 19 (8), 1580-5 PMID: 21512511