Clinical encounters about obesity: Systematic review of patients' perspectives

Abstract

SummaryGuidelines recommend clinicians intervene on obesity but it is unclear how people with overweight react. In this systematic review, we searched 20 online databases for qualitative studies interviewing people with overweight or obesity who had consulted a primary care clinician. Framework synthesis was used to analyse 21 studies to produce a new theoretical understanding. Consultations in which patients discussed their weight were more infrequent than patients would have liked, which some perceived was because they were unworthy of medical time; others that it indicated doctors feel being overweight is not a serious risk. Patients reported that doctors offered banal advice assuming that the patient ate unhealthily or was not trying to address their weight. Patients reported doctors assumed that their symptoms were due to overweight without a proper history or examination, creating concern that serious illness may be missed. Patients responded positively to offers of support for weight loss and active monitoring of weight. Patients with overweight internalize weight stigma sensitizing them to clues that clinicians are judging them negatively, even if weight is not discussed. Patients' negative experiences in consultations relate to perceived snap judgements and flippant advice and negative experiences appear more salient than positive ones.

Weight assessment and the provision of weight management advice in primary care: a cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom

“…upsetting patients), and scepticism about the efficacy of advice [22,23,[44][45][46][47][48][49][50][51]. Similar themes have also been reported in patient-focused research [20,21,31]. Some of these barriers are also reportedly aggravated among GPs, in particular concerns about moving the consultation away from the patient's agenda, and harming their doctorpatient relationship [45].…”

“…This is despite the same study finding that almost all adults had seen a healthcare practitioner in the past year. These trends are corroborated in wider examinations of patient records, self-reported frequency of assessing weight and providing referrals among primary care practitioners, and observations of primary care consultations [11,[25][26][27][28][29][30][31][32]. Moreover, even when weight is assessed and a referral to a specialist weight management service is made, only around a third of patients reportedly attend the referral at all and fewer complete the referral in full [33].…”

“…receiving advice in patient research, self-report research with primary care practitioners, observations of consultations, and examinations of patient records [24][25][26][27][28][29][30][31][32].…”

“…Future research should therefore explore whether increased emphasis on any of the lesser reported prompts could increase assessment and advice provision, with previous research supporting the potential efficacy of computer prompts [54,55], financial incentives [56,57], or multicomponent interventions [14]. It is also important that any alternatives are implemented in a manner that reduces, or avoids exacerbating, concerns among patients that they are being stigmatised [31] or existing barriers reported among practitioners. Put simply, continued examination and evaluation of what works, and why, for practitioners and patients is essential.…”

“…Practitioners were asked 'Thinking now about all the patients that you saw in the last year who are obese (with a recorded BMI of [30][31][32][33][34][35], how often did you provide weight management advice?' Answers were provided on a fivepoint scale (1 = Always-5 = Never) and binary coded (1 = Always/Often, 0 = Less often/Never).…”