Like many diseases, obesity is the result of interlocking causes that vary with each patient. Upbringing, culture, access to information and optimal nutrition, 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, including 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 applying 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.
The Built Environment
For obesity medicine in urban areas, it is important to consider the built environment that patients occupy, such as structures, parking lots, green or recreational spaces, waste areas, and the types of businesses operating nearby. 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 maintain healthy eating patterns. And air pollution in a neighborhood may further discourage physical activity or even contribute to obesity by itself.
The Social Environment Also important in promoting or inhibiting treatment 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? How much visible disorder, such as vandalism, are they exposed to?
These factors increase stress and are associated with increased behavioral triggers, impacting nutritional choices, decreased physical activity, and predictably, increased rates of obesity. When stress hormone 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 overcome greater obstacles with fewer resources in their comprehensive care plan to treat obesity.
Helping Patients With Obesity Living in Urban Areas
When designing treatment plans, healthcare professionals should meet patients where they are and take into consideration potential social determinants of health that impacts care. Set realistic goals that consider the patients’ built and social environments, follow up frequently, and strive to work with your patient to create a comprehensive, sustainable, and long-term treatment plan.
If you feel an individual is not implementing their care plan, remember that a barrier—not the individual—is likely to be impacting their ability to implement the care plan. When we take the time to understand how social and physical determinants influence chronic management of obesity, we can provide better, more successful care.
To learn more about obesity treatment and discover resources you can leverage in your healthcare practice, visit: https://obesitymedicine.org/join.