60 percent of Americans are currently trying to lose weight

Americans take obesity as seriously as cancer, and say it's an even bigger health threat than heart disease, the nation's leading killer, yet most do not go beyond traditional diets or involve doctors in their largely unsuccessful personal struggles against the disease, according to a new survey by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the independent research organization, NORC at the University of Chicago. The findings were released here during ObesityWeek 2016, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity.

The ASMBS/NORC Obesity Poll finds that 81 percent of Americans consider obesity to be the most serious health problem facing the nation, tying cancer as the top issue, ahead of diabetes (72 percent), heart disease (72 percent), mental illness (65 percent), and HIV/AIDS (46 percent). In 2011- 2014, the Centers for Disease Control and Prevention (CDC) reports the prevalence of obesity was more than 36 percent in adults, a number that has grown significantly in the last 10 years.

Nearly everyone (94 percent) agrees that obesity itself increases the risk for an early death, even if no other health problems are present, according to the new poll. Yet, despite the seriousness with which they take the threat, the vast majority of Americans incorrectly perceive diet and exercise alone to be the most effective long-term weight loss method, and 1 in 3 of those struggling with obesity, report that they have never spoken with a doctor or health professional about their weight. Only 12 percent of those with severe obesity, for whom weight-loss surgery may be an option, say a doctor has ever suggested they consider surgery.

"This survey reveals that Americans understand the risks of obesity better than ever, but hold major misperceptions about the causes of the disease, the effectiveness of the different treatments and the importance of involving the medical community in their care," said Raul J. Rosenthal, MD, President, ASMBS and Chairman, Department of General Surgery, Cleveland Clinic Florida. "I think obesity may be the only life-threatening disease where more than a third of the patients do not consult a doctor for treatment, and where the vast majority do not explore other treatment options that may yield better long-term success rates."

The ASMBS/NORC Obesity Poll finds about 60 percent of Americans are currently trying to lose weight, although most everyone with obesity has tried before (94 percent). More than half of those with obesity have tried at least five previous times, and 1 in 5 have made more than 20 attempts to lose weight over their lifetimes. Only 22 percent of obese Americans rate their health positively, and half report being diagnosed with two or more chronic conditions.

Most Americans consider diet and exercise on one's own to be the most effective method (78 percent) for long-term weight loss, saying it's even more effective than weight-loss surgery (60 percent) and prescription obesity drugs (25 percent).

"Diet and exercise alone is simply not the most effective long-term treatment. It's an important component, but on its own, it's probably the least effective option for most people with obesity," said John M. Morton, MD, MPH, chief of bariatric and minimally invasive surgery at Stanford University School of Medicine and ASMBS immediate past president. "We have to get people, and even the medical community, to go beyond 'eat less and exercise more.' That's too simple an answer for a complex disease like obesity. We have an expanding spectrum of treatments and many are underutilized because they are misperceived or poorly understood."

When it comes to safety, 88 percent of Americans say losing weight through diet and exercise, especially with the help of a doctor, is the safest way to go, while prescription medications (15 percent) and dietary supplements (16 percent) are perceived to be the least safe. As for weight-loss surgery, Americans are divided, with about one-third of each who believe it to be safe (31 percent), unsafe (37 percent), or neither safe nor unsafe (31 percent). Despite the mixed feelings, a majority of Americans (68 percent) think that living with obesity is still riskier than having weight-loss surgery.

Using self-reported height and weight to calculate body mass index, the ASMBS/NORC Obesity Poll assessed a person's perceptions of their own weight status, and 57 percent of obese respondents underestimated where they were. Almost half (47 percent) said they were overweight or about the right weight (10 percent). Men were more likely to underestimate their weight than women (66 percent vs 50 percent).

"Obesity in America is a constant struggle for many adults, one filled with worry, denial, conflicted thinking and significant health concerns," said Trevor Tompson, Vice President at NORC at the University of Chicago. "The survey shows there's a significant need for education so that Americans can better match the health risks and impact of obesity on their lives with the actions they take and the treatments they choose."

Part of the issue may be that the public thinks about obesity differently than the medical community. While health professionals have generally reached consensus that obesity is a disease (the American Medical Association and other medical groups declared it so in 2013), little more than one-third (38 percent) of Americans agree, with most considering it simply a risk factor for other diseases. Additionally, health experts say obesity is caused by a combination of genetic, environmental, and social factors, yet many Americans (48 percent) believe it is caused primarily by a person's lifestyle choices and that the biggest barrier to weight loss is a lack of willpower (75 percent).

For many Americans, concerns about their weight can dominate their life. The ASMBS/NORC Obesity Poll found that 1-in-3 of all Americans worry about gaining weight all or a good deal of the time, but that those with obesity are more than twice as likely to report being chronically worried (54 percent) than non-obese individuals (20 percent). Of those who worry about their weight, the majority are extremely or very concerned about the health consequences. In fact, it appears nearly all Americans (98 percent) at this point know about the increased risk that obesity poses for developing diabetes and most know about the increased risk for developing certain types of cancer (82 percent).

The nationally representative survey of 1,509 adults was funded by ASMBS and used AmeriSpeak, the probability-based panel of NORC at the University of Chicago. It included oversamples of African Americans and Hispanics and was conducted between August 11 and September 21, 2016. The unique capabilities of AmeriSpeak enabled the survey to be done online as well as with landlines and cell phones with high rates of participation. The margin of sampling error is +/- 3.5 percentage points.

Two reports are associated with the survey: "Obesity Rises to Top Health Concern for Americans, but Misperceptions Persist," and, "New Insights into Americans' Perceptions and Misperceptions of Obesity Treatments, and the Struggles Many Face."

People with obesity and severe obesity have higher rates of heart disease, diabetes, some cancers, arthritis, sleep apnea, high blood pressure and dozens of other diseases and conditions. Studies have shown individuals with a BMI greater than 30 have a 50 to 100 percent greater risk of premature death compared to healthy weight individuals.