"Just put in a little more effort": the help-seeking experience of patients living with obesity.

Background: Early detection of the disease obesity and support for patients living with obesity could improve the success of obesity treatment and management. The factors influencing the delay in obesity treatment, defined as the period between obesity onset and treatment start, are largely unknown. The aim of our study is to explore the help-seeking behavior of PwO towards obesity treatment.

Methods: In this cross-sectional qualitative study, consecutive patients visiting the obesity clinic of the University Hospitals of Brussels between December 2023 and April 2024 were invited to participate. PwO were interviewed, and data were transcribed and analysed using thematic analysis.

Results: A total of 18 PwO (61% female, median age 37 years, (IQR: 23.5-57.5)) were interviewed. The journey of PwO towards obesity care seemed complex with multiple HCPs involved. Four themes were identified as triggers for seeking obesity care: Referral from primary care, family, friends and schools; Health complications; Financial burden of living with obesity; and Increased internal motivation. Three themes were identified as factors increasing treatment delay: Inefficient referral; Pressure from society to try lifestyle approaches first; and Challenges to overcome barriers for metabolic surgery. Inefficient referral from dietitians to multidisciplinary obesity treatment was identified as the main cause of treatment delay. PwO feel discouraged by the limited effectiveness of dietary guidance, leading to disengagement from the healthcare system.

Conclusion: Our findings identify several key barriers contributing to treatment delays for patients with obesity. People living with obesity emphasized the need for an obesity care pathway and improved communication among primary care providers, allied health professionals, and collaborating centres for obesity management (COMs) to reduce the time required to access appropriate obesity treatment. Additionally, societal perceptions framing obesity as a result of a lack of willpower were reported by patients with obesity as a barrier to seeking care.