Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study

Abstract

ObjectiveTo understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland.SettingSeven National Health Service (NHS) Scotland primary care centres.ParticipantsA total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated.Design and methodologyA cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives.Results(1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors.ConclusionsIncongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

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

“…This may help to explain why PNs were more likely to report frequently assessing BMI and more likely to provide weight management. This is in addition to wider suggestions that believing weight to be part of their chronic disease and health promotion remit, confidence in their ability to build patient rapport, and being encouraged to attend training and make time for weight management may also facilitate more frequent weight management practice among PNs [22,45,52]. That almost all PNs were female also explains why gender was also associated with greater likelihood of, or more frequent, weight management practice.…”

“…Examples include lack of time or competing priorities, knowledge of obesity guidelines or relevant training, concerns of sensitivity or negative consequences (e.g. 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].…”

“…Patients believe that primary care practitioners play an important role in weight management are expectant they will discuss the issue if required [20,21], while primary care practitioners similarly acknowledge they play a key role in obesity prevention [22,23]. A nationally representative survey, however, suggests that only around a fifth of adults in the UK have received advice about weight management from a healthcare practitioner, including less than half of those who had an obese BMI [24].…”

A Practical Approach to the Patient with Obesity

“…Obesity has become a major global and regional health problem, resulting in reduced quality of life, higher healthcare costs, and increased mortality. [3][4][5][6] However, according to international surveys and interviews, people with obesity may not perceive their weight to be a significant problem 7 . Even if they do, it may take some years of struggling with excess weight before they finally consult a healthcare professional.…”

Qualitative study on the key elements of obesity counseling in Korean Medicine

“…In those situations, counseling for weight loss is easily overlooked and doctors tended to have negative attitudes towards it. [ 14 – 16 , 18 ]…”