A taboo topic? How General Practitioners talk about overweight and obesity in New Zealand

Abstract

INTRODUCTION Obesity is overtaking tobacco smoking in New Zealand as the leading potentially modifiable risk to health. International obesity guidelines recommend that health professionals opportunistically encourage weight management with their patients. However, research shows consistently low rates of weight management discussion, suggesting that health professionals may not be realising their full potential to address obesity. AIM To identify communication strategies used by General Practitioners (GPs) to open the topic of weight and weight management in routine consultations. METHODS A secondary analysis was conducted of 36 video-recorded consultations in general practices, selected for relevance from a database of 205 consultations. Content and interactional analysis was conducted in the context of the entire consultation. RESULTS The topic of weight was initiated more often by GPs than patients and was raised mostly once or twice in a consultation and occasionally as many as six times. GPs employed opportunistic strategies twice as often as they used structured strategies. DISCUSSION This study of naturally occurring consultations confirmed GPs do engage in opportunistic discussions about weight. However, such discussions are challenging and interactionally delicate. Highlighting the clinical relevance of weight appears to be effective. The high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight. Further research is required to identify suitable training and brief intervention tools for use in routine consultations that may be beneficial for both GPs and patients.

Prenatal care experiences among pregnant women with obesity in Wisconsin, United States: a qualitative quality improvement assessment

“…The importance of using the preferred weight-related terminology cannot be underestimated. Studies have shown that using the wrong weight status terminology can offend women and weaken patient-provider relationships [44]. Professional medical organizations such the American Medical Association recommend using "nonstigmatizing" language when it comes to discussing high BMIs and weight with patients but do not make recommendations on specific language that would not be stigmatizing [45].…”

Kommunikationspräfenzen im Kontext von Adipositas

“…Insgesamt zeigt sich in unserem Sample im Einklang mit Vorstudien [7,8,16,25], dass Übergewicht im Kontext anderer medizinischer Fragen besprochen wird. Im Umkehrschluss bedeutetdies, dass das Thema selten angesprochen wird, wenn zwar hohes Körpergewicht, aber keine medizinischen Probleme bestehen.…”

“…Familie und Freunde können als wichtige Quelle gelten [16], es sind allerdings auch Fälle dokumentiert, in denen Betroffenen nach der Gewichtsreduktion Ablehnung durch ihr Umfeld erfahren [21]. Ärzte spielen in der Prävention und Behandlung von Folgeerkrankungen ebenfalls eine zentrale Rolle, wenngleich davon auszugehen ist, dass das Potenzial der Beratung nicht voll ausgeschöpft ist [7,12]. Eine gute Beziehung zwischen Arzt und Patient etwa kann eine erfolgreiche Gewichtsreduktion begünstigen [13], jedoch weist das Thema einige kommunikative Herausforderungen auf.…”

“…Aus der bisherigen Studienlage lassen sich weiterhin zwei allgemeine Tendenzen festhalten: Vorstudien zeigen erstens, dass gerade Vorhaltungen und Belehrungen beim Thema der lebensstilbedingten Erkrankungen die Kommunikation erschweren [7]. Zweitens bringen Ärzte das Gewicht häufiger als ihre Patienten zur Sprache [7], gehen dabei jedoch meist nicht standardisiert vor, da das Thema des hohen Körpergewichts v. a. im Kontext anderer Erkrankungen virulent wird. Heintze et al [8] stellten beispielsweise heraus, dass in Beratungsgesprächen auf Übergewicht eher indirekt und in Verbindung mit den Laborwerten referiert wurde.…”

From the Editor: Reading, writing and research impact

“…2 As the name suggests, Altmetrics is an alternative measure of research impact that uses social media (such as Facebook, Twitter, and news outlets) to measure the amount of attention a paper attracts. We have published several papers that have very high Altmetric scores and that makes us happy (eg [3][4][5][6] ). However, Altmetrics does not tell us about the ultimate measure (reading) and there is not much association between an Altmetrics score, or the number of times a paper is cited, or the number of times a paper is read.…”