Like many diseases, obesity is the result of inter- locking causes that vary by patient. Upbringing, culture, access to information and optimal nutri- tion, psychosocial profile, exposure to pollution and stress, and a host of other factors can trigger existing genetic substrates to promote obesity.

As healthcare professionals, it is imperative that we get to know any individual we treat holistically, in- cluding the external factors that will impact their care plan. By initiating social factor conversations, we can create a comprehensive care plan that can be successfully implemented, optimizing available resources. When I feel an individual is not apply- ing their care plan that we had created utilizing shared decision making, there is usually a barrier present that impacts their ability to implement it. When we take the time to understand how social factors influence care, we can help our patients achieve more long-term, sustainable success.

For obesity medicine in urban areas, it is import- ant to consider the built environment that patients occupy and the types of businesses operating near- by. These elements can have an obesogenic effect.

If a neighborhood has few grocery stores and many convenience stores—which typically offer energy-dense, highly processed, nutrient-poor food—local residents may be less likely to main- tain healthy eating patterns. And air pollution in a neighborhood may further discourage physical activity or even contribute to obesity by itself.

Also important in promoting or inhibiting treat- ment for a patient with obesity is their social environment. In urban settings, many obesity treatment challenges are mediated through stress, especially in under-resourced areas. What is the poverty level in your patients’ neighborhood? How much violence occurs?

These factors increase stress and are associated with increased behavioral triggers, impacting nutrition- al choices, decreased physical activity, and predict- ably, increased rates of obesity. When stress hor- mone pathways overlap with the brain’s regulation of appetite and energy maintenance, high stress levels have been shown to affect eating patterns. Patients in disadvantaged urban areas must over- come greater obstacles with fewer resources in their comprehensive care plan to treat obesity.

When designing treatment plans, healthcare pro- fessionals should meet patients where they are and take into consideration potential social determi- nants of health that impacts care. Set realistic goals that consider the patients’ built and social envi- ronments, follow up frequently, and strive to work with your patient to create a comprehensive, sus- tainable, and long-term treatment plan.

If you feel an individual is not implementing their care plan, remember that a barrier—not the indi- vidual—is likely to be impacting their ability to implement the care plan. When we take the time to understand how social and physical determi- nants influence chronic management of obesity, we can provide better, more successful care.