Only 10% of health is determined by care received at a doctor's office. Other factors like economic stability, residential environment, education, food, and community play a significant role in health outcomes. Individual behavior, including, where we live, what we do for a living, and what services we have access to make up 60% of our health. Clinical advice when combined with focus on individual behavior and social factors can result in superior health outcomes.
Typical weight loss programs have focused on a combination of right diet and exercise. Counselling on right nutrition is useless to a person living in a food desert. Inaccessibility to whole food results in not being able to maintain a healthy diet dooming the weight loss program participant. Others have argued that food swamps contribute to unhealthy eating – a neighborhood where fast food and junk food outlets outnumber healthy alternatives. Relationship between food swamps and obesity was especially strong in areas where people lacked both their own cars and access to transportation.
Regardless of access to healthy food, personal beliefs and education play a key role in weight loss/obesity. Research shows that individuals who believe exercise and not diet is critical for weight loss tend to lose less weight that those who believe diet is crucial for weight loss. In multiple samples across the world, approximately half the population mistakenly believes that lack of exercise is the primary cause of obesity. These misbeliefs have consequences: people who underestimate the importance of one’s diet are more likely to be overweight or obese than people who correctly believe that diet is the primary cause of obesity. Belief that exercise is important over diet results in over-exercise and reduced importance to diet resulting in lower weight loss.
Screening tools are an efficient mechanism to gather data about social factors. Armed with data about social factors, a standard weight loss program can be tailored to address the social and clinical needs of an individual. These could be referrals to food banks, information about healthy eating, or the relative importance of diet and exercise or the impact of medication non-adherence on hunger/eating. Holistically addressing social factors and beliefs in conjunction with weight loss programs will result in improved outcomes.