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5 Ps Obesity Barriers; Why Obese patients cannot Achieve Target Weight?


Lack of standard definition of obesity parameters in different age groups or in different ethnic groups. Too many parameters (Waist Hip ratio vs. Waist Height ratio). Central obesity vs. peripheral obesity. Upper body obesity vs. lower body obesity. Obesity with risk factors vs. Obesity without risk factors.

Providers (Physicians, Health care providers) 

Clinical inertia due physicians’ uncertainties on how to approach obese patients.
 Physicians’ uncertainties on medical management of obesity.
Failure to refer obese patients to obesity specialist health care providers.

Policies and procedures

Lack of agreement on the factors that caused obesity epidemic (diet, life style, genetics, epigenetic).
Limited special services for obesity management.
 Lack of clear algorithms, plans on how to tackle obesity for each community. 
Limited resources to secure patients benefits from any existing obesity service. 
Limited resources to start a new obesity services.


Barriers to anti obesity medication 
 Fears of side effects of possible lifelong anti obesity medication.
Fears of injections for weight loss (GLP1).
Fears for women of falling pregnant while on anti obesity medication, or side effects of medication during breast feeding.
 Barriers to diet 
 Difficulty in adherence to a diet plan and to maintain the adherence.
Financial constrains to follow certain dietary recommendation (dietary advice cost, food cost like high protein diet).

Barriers to exercises 

 Difficulty in initiating and maintaining exercise program (whether structured or opportunistic).
 Financial constrains to engage into structured exercise program.

Barriers to Bariatric Surgery 

 Fears of any surgical intervention (gastric bands, gastric balloons and Bariatric surgeries).
 Financial constrains (Bariatric procedures are not covered by insurance, nor by health care systems).
 Limited availability of post surgical care plan.

Pathways (Paradigms)

 Lack of clear pathways on life style management of obesity.
 Lack of clear pathways on medical management of obesity (What medication to which patients? What doses of medication? How long to continue pharmacotherapy).
 Lack of pathways on management of obesity in the vulnerable groups (elderly, children, pregnant women).
 Lack of clear pathways on surgical management of obesity (which procedure suit each patient? What are the cares plans following each bariatric procedure, how frequent patients need to be seen following different types of bariatric procedures, what micronutrient need close monitoring after each bariatric procedure. 


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