Role of the family doctor in the management of adults with obesity: a scoping review

Abstract

ObjectivesObesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology.SettingPrimary care. Adult patients.Included papersPeer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review.Primary and secondary outcome measuresData were extracted on the family doctors’ involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned.Results110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations.ConclusionsThere is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development.

Management of overweight and obesity in primary care—A systematic overview of international evidence‐based guidelines

“…The results are to be incorporated in clinical pathways for primary care teams. A scoping review published by Sturgiss in 2018 showed that the literature is divided on the role family doctors and other health professionals should play in obesity management. Although general practitioners are mostly involved in diagnosis and assessment, their role in obesity care is often underestimated .…”

“…A scoping review published by Sturgiss in 2018 showed that the literature is divided on the role family doctors and other health professionals should play in obesity management. Although general practitioners are mostly involved in diagnosis and assessment, their role in obesity care is often underestimated . Another review concluded that studies performed in primary care provide little evidence on the effectiveness of overweight and obesity management and that further research is needed to define the role of primary care providers in the context of comprehensive and multi‐professional care .…”

“…54,55 In addition, a qualitative study investigating the beliefs, skills, and knowledge of involved researchers, practitioners, and patients reported that close multidisciplinary collaboration and knowledge about the role of each participant in the management process, combined with continuous monitoring, may contribute towards treatment success. 56 The aim of this project was to provide a clear and systematic 57 Another review concluded that studies performed in primary care provide little evidence on the effectiveness of overweight and obesity management and that further research is needed to define the role of primary care providers in the context of comprehensive and multi-professional care. 58 As most trials are performed in specialist obesity clinics and research centres, trials in primary care and information on long-term health outcomes are only available to a limited degree.…”

Attitudes and treatment practice of general practitioners towards patients with obesity in primary care

“…It is important to identify current barriers to the weight management of patients in primary care in order to improve their treatment. According to a recent review of obesity management in primary care, Germany has not conducted many surveys on managing obesity, as compared to other countries, in particular the USA [9]. Consistent findings have been reported with regard to stigmatizing attitudes in health care [10].…”

A qualitative study exploring the views of individuals with knee osteoarthritis on the role of physiotherapists in weight management: A complex issue requiring a sophisticated skill set

“…Relatedly, patients viewed the physiotherapists' role in knee OA management as being situated within a GP-led healthcare team. GPs are often the first point of contact for people with musculoskeletal disease; however, data from Australia show that GPs give advice regarding weight loss in only 15% of knee OA patients (Brand et al, 2014), consistent with the low levels of obesity advice given by physicians internationally (Sturgiss, Elmitt, Haelser, van Weel, & Douglas, 2018). By contrast, GP referral to other health practitioners is the most frequent mode of nonpharmacological management (Brand et al, 2014).…”