Obesity professor says patients are not always properly examined

Obesity patients are not always properly examined in healthcare, Professor Kirsi Pietiläinen of the University of Helsinki told Yle. Her research group will investigate, at Kela’s request, how obesity is treated across Finland’s wellbeing services counties.

Pietiläinen said healthcare providers should at least check patients’ blood pressure, blood sugar and cholesterol levels.

“Obesity treatment has become somewhat about writing prescriptions for medication. For some patients, a proper assessment of their health is missing,” she said.

A doctor can prescribe obesity medication when a patient’s body mass index is above 30. The threshold can be 27 for people whose weight loss would ease an obesity-related illness, such as diabetes or knee osteoarthritis.

Blaming patients does not help

Pietiläinen said treatment can also be of poor quality when it is available.

“I may be living in a pink cotton-wool nest. I think the world has changed because there is a young generation of doctors who are tolerant and respect people of all sizes,” she said.

Pietiläinen teaches medical students about obesity treatment and respectful encounters with obese patients in healthcare. She said the students did not find this difficult, leading her to believe that healthcare no longer blamed people for their obesity.

She realised she was mistaken after asking people on social media about their experiences of being treated in healthcare. She received a couple of hundred replies in four days, most of them negative.

Respondents said healthcare workers assumed that obese people were lazy, sat on the sofa eating crisps and had never tried to change. Some were told to simply change their behaviour and pull themselves together.

According to Pietiläinen, a blaming approach in appointments does not help patients.

“On the contrary, someone might make changes in their life as a result of a good encounter,” she said.

People’s lifestyles are also influenced by factors such as the restaurants available in their local area, transport arrangements and opportunities for exercise. Obesity is partly linked to genes and a biological tendency to gain weight. Shops also want to sell treats, which can be difficult to resist.

“The human body is designed to store energy reserves,” Pietiläinen said.

Preventive care could save money

Pietiläinen hopes obese people will receive preventive treatment before obesity-related illnesses develop.

She said Finland’s healthcare system was under such pressure that very few of its limited resources were directed towards obesity treatment.

“It is short-sighted. People need and want help, but healthcare is stuck,” she said.

Prevention and early treatment could save money later, Pietiläinen said. She argued that money was now being spent on treating illnesses, some of which are caused by obesity.

A Finnish study published in BMC Public Health in 2025 found that overweight people generate significantly higher costs for society than people of normal weight.

There is no risk-free obesity

Not all obese people suffer from metabolic health problems such as cardiovascular disease, type 2 diabetes or fatty liver disease.

This has led to terms such as “metabolically healthy obesity” and “benign obesity”, which are discussed in a recent international research article in the American Journal of Preventive Cardiology.

The article says about one-third of obese people are metabolically healthy. Pietiläinen said, however, that the study’s criteria for health were too broad. Earlier research literature, she said, put the proportion of metabolically healthy obese people in Finland at about 10 per cent.

The recent study also states that obesity without metabolic abnormalities cannot be called benign obesity, because obesity is nevertheless associated with health risks that can develop into illnesses as the condition progresses.

Metabolic diseases can also affect people of normal weight. For example, fatty liver caused by diet and physical inactivity is also found among people of normal weight.