A systematic review and thematic synthesis of qualitative studies exploring GPs' and nurses' perspectives on discussing weight with patients with overweight and obesity in primary care

Abstract

Summary Guidelines and evidence suggest primary care clinicians should give opportunistic interventions to motivate weight loss, but these rarely occur in practice. We sought to examine why by systematically reviewing qualitative research examining general practitioners' (‘GPs’) and nurses' views of discussing weight with patients. We systematically searched English language publications (1945‐2018) to identify qualitative interview and focus group studies. Thematic methods were used to synthesise the findings from these papers. We synthesised the studies by identifying second‐order themes (explanations offered by the original researchers) and third‐order constructs (new explanations which went beyond those in the original publications). Quality assessment using the Joanna Briggs checklist was undertaken. We identified 29 studies (>601 GPs, nurses and GP trainees) reporting views on discussing weight with patients. Key second‐order themes were lack of confidence in treatments and patients' ability to make changes, stigma, interactional difficulty of discussing the topic and a belief of a wider societal responsibility needed to deal with patients with overweight and obesity. The third‐order analytical theme was that discussions about weight were not a priority, and other behavioural interventions, including those relating to smoking, often took precedent. GPs and nurses reported that noting body mass index measurements at every consultation alongside a framework to deliver interventions would likely increase the frequency and perceived efficacy of behavioural weight interventions. GPs and nurses acknowledge the importance of obesity as a health issue, but this is insufficient, particularly amongst GPs, for them to construe this as a medical problem to address with patients in consultations. Strategies to implement clinical guidelines need to make tackling obesity a clinical priority. Training to overcome interactional difficulties, regular weighing of patients and changing expectations and understanding of weight loss interventions are also probably required.

A Community Jury on initiating weight management conversations in primary care

“…Previous research suggests physicians are concerned about offending their patients if they discuss weight management 7 , 26 and do not see it as priority. 10 However, this study suggests discussions may be welcomed if the focus is on health, and patients are able to decline such conversations. Moreover, many jurors felt it would be the doctor's duty to have those conversations.…”

“… 7 , 8 , 9 A recent systematic review and thematic synthesis of 29 qualitative studies exploring GPs' and nurses' perspectives on discussing weight with patients with overweight and obesity in primary care highlighted that discussing weight is not perceived to be a priority for GPs. 10 …”

People withweight‐related long‐termconditions want support fromGPs: A qualitative interview study

“…However, none of these studies has focussed on weight‐related long‐term conditions. A recent review of qualitative studies with primary care staff 14 found mixed views about whether there was enough evidence to support GPs to advise people who are overweight (there is). Even among those who did see it as “part of the job” to advise weight‐management, some suggested that limited time in the consultation meant that staff prioritized other, more effective, discussions 14 …”

“…Health professionals report embarrassment and concern about offending patients who are overweight, and some are unconvinced that people who are overweight will successfully make changes 8,11,13 . A recent review concluded that discussions about weight management are not a high priority for GPs 14 . However, surely GPs should not feel reluctant to raise the topic when the patient has a known, weight‐related long‐term health condition?…”

Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

“…Concern about regain in weight and the long term value of attempts at weight loss has been identified as a barrier to engagement in behavioural weight loss programmes from patients and healthcare providers. 2 Considerable research has been done on developing and testing specific weight loss maintenance programmes, but with little success. 3 4 Programmes have achieved modest success, with behavioural support intended to promote lasting adherence to changes in diet and increased physical activity.…”