What advice is being given by general practitioners to people living with obesity?

General practitioners (GPs) are inspired to use all opportunities to talk about weight to people living with obesity. This is highlighted in several public health policies worldwide, including in Canada, the United States, and the United Kingdom. Weight-loss interventions lead to the improvement of the health, weight, and well-being of individuals. This, in turn, benefits the healthcare systems and reduces overall healthcare costs across populations.

Background

GPs must work towards making every communication with the patient count and regularly talk to the same patient. Patients indicate they would like to speak to a GP about their weight loss, with the family practice being their preferred setting. Research indicates that even brief talks with patients are associated with weight loss.

However, GPs rarely talk to patients with obesity about their weight. Weight is a low-priority topic in consultations since GPs are unsure what advice to give patients; they feel that advice will not be effective, and they sometimes lack knowledge regarding the best ways to lose weight.

Previous trials have indicated that referrals to weight management programs can be effective for people with obesity. However, they are inaccessible to all patients due to commissioning in the United Kingdom. Therefore, there is an increased requirement for GPs to offer weight-loss advice to patients with obesity.

A new study in Family Practice aimed to analyze the advice given by GPs during short consultations to patients living with obesity.

About the study

The study involved the recruitment of 137 GPs who attended patients with a body mass index ≥30 kg/ m2 between 4th June 2013 and 23rd December 2014. The participating GPs offered a free 12-week referral to a community weight management service (support arm) or brief weight-loss advice (advice arm). Most of the patients were randomized to audio-record their interventions.

Out of the 237 recordings available, 159 were randomly selected and analyzed. Qualitative conventional content analysis (QCCA) was used to determine the advice given by the GPs to patients with obesity.

Study findings

The results indicated that out of the 159 patients, 92 were female, 62 were male, and the data was missing for five patients. The mean age was observed to be 57 years, and the body mass index was 35 kg/m2. The mean length of the recordings of consultations was reported to be 92 seconds.

The results reported that GPs advised to make dietary changes in 44 out of the 159 consultations and later went on to discuss physical activity. Twenty-three consultations focused only on physical activity, while 14 included diet and physical recommendations. GPs recommended changing the type or amount of food consumed by people in 26 out of the 159 consultations. They also recommended changing food choices and rarely monitoring calories.

Moreover, GPs also gave specific diet recommendations to the patients, such as low-fat diets and intermittent fasting. They also focused on increasing physical activity volume in 18 consultations along with specific guidance or gym prescriptions. GPs were reported to recommend implementation tips in 33 consultations which included eating smaller portions, daily or weekly self-weighing, avoiding alcohol, eating at different times of day, changing mindset, and using smaller plates.

GPs also suggested signposting patients somewhere else or follow-up consultations in 78 consultations. GPs were reported to provide superficial advice on losing weight when patients were experiencing difficulty in losing weight in 58 consultations. They provided personalized advice in 30 out of 159 consultations. In four consultations, GPs provided a reason for the advice they were providing, out of which two were from external sources and 2 were general advice whose source was not specified.

Therefore, the current study demonstrates that clinicians are not sure what effective advice must be given to people with obesity. In most cases, they cannot provide effective advice, which results in no weight loss for the patients. Further guidelines and training are required to improve the weight-loss advice given by GPs to people living with obesity.

Limitations

The study has two main limitations. First, the clinicians participating in the study received training on brief interventions for weight loss which might result in them giving different advice than untrained clinicians. Second, the clinicians in this study were told to give weight-loss advice within 30 seconds.

Written by

Suchandrima Bhowmik

Suchandrima has a Bachelor of Science (B.Sc.) degree in Microbiology and a Master of Science (M.Sc.) degree in Microbiology from the University of Calcutta, India. The study of health and diseases was always very important to her. In addition to Microbiology, she also gained extensive knowledge in Biochemistry, Immunology, Medical Microbiology, Metabolism, and Biotechnology as part of her master's degree.