Anyone involved in chronic disease management is well aware how difficult it is for patients to stick with even the simplest of medical regimens – just taking a tablet once a day. This is even more difficult for patients with psychiatric issues (present in over 40% of treatment-seeking patients with obesity). Less than half of patients prescribed medication for depression will still be on their drug 3 months after initiation; with bipolar disorder, this rate drops to only 35%.
Pharmacological obesity trials regularly show high-rates of discontinuation (around 20-40% at 12 months), not very different from that seen in real life for blood pressure or lipid-lowering medications.
If simply taking a tablet is so hard to stick to, how much more difficult is it to actually make lifestyle changes and stick with them? No question, patients struggling with excess weight need constant coaching, reminders, self-monitoring, support systems – left to their own devices the vast majority of patients will fall back into their old patterns resulting in weight regain.
As I often say – there are only two types of obese patients – those that are untreated and those that are treated. The only difference between the two groups is the fact that patients in the treatment group are managing their weights – when treatment stops, group 2 reverts to group 1 – i.e. the weight comes back or continues to increase – there are no exceptions!
As with other chronic diseases, our challenge in obesity is not how to get patients to start treatment – the challenge is how to get patients to stick with the treatment forever.
Schematic: World Health Organization, 2003