Introduction: Obesity prevalence is high, requiring effective and scalable treatment options. German guidelines recommend referral to multimodal treatment programmes. However, reimbursement by statutory health insurance remains fragmented. Little is known about how people with overweight and obesity engage with available support in Germany. Methods: An online survey was administered to a representative sample of adults living with overweight or obesity in Germany. Participants reported awareness, use, interest and perceived barriers regarding uptake of (a) primary care consultations, (b) behavioural programmes (c) and pharmacotherapy for obesity. Results: A total of 2065 respondents (46.5% women; 53.3% with overweight; 46.7% with obesity) were included. Most had experience with weight management (85.5%), but approaches were predominantly self-directed (75.1%). Engagement with professional obesity care was limited (Conversations with general practitioners: 43.1%; participation in structured behavioural weight management programme: 7.8%; use of pharmacotherapy: 6.2%). Awareness and interest varied across treatment modalities, with particularly low awareness (19.6%) but high interest (39.1%) in behavioural programmes. Common barriers included lack of awareness, concerns about long-term effectiveness and side effects, and perception that support was not yet necessary. Conclusion: We identify a substantial evidence-practice gap in German obesity care, characterised by low reported use of professional support despite widespread weight management attempts. Beyond improving access and availability of services, effective obesity care also requires better communication on the effectiveness of evidence-based treatments, in particular behavioural programmes. Additionally, promoting a long-term, chronic-disease model of obesity and weight management may help align expectations, reduce discontinuation, and support sustained engagement with care.
Kudlek et al. (Tue,) studied this question.