Obesity needs to be treated in primary care

Given the staggering prevalence of overweight and obesity in most developed countries, there is no other hope than to have general practitioners (and their allied health colleagues) take on the considerable burden of managing obesity in their practices.

In fact, a recent example of a successful weight management program run in primary care just found considerable media attention in local newspapers.

But research shows that most general practitioners (GPs) neither feel confident nor effective in managing excess weight in their patients, and many would rather not bring up the topic of weight management at all.

So what about GP trainees? After all, the next generation of GPs will have little choice but to devote a considerable proportion of their time and practice to dealing with weight-related health issues.

This question was now addressed by Jochemsen-van der Leeuw and colleagues from the University of Amsterdam, in a paper published in Family Practice.

For this study, the researchers conducted focus groups of first- and third-year Dutch GP trainees and their teachers regarding their attitude, willingness, and ability to provide lifestyle interventions for overweight patients.

First-year GP trainees clearly lacked both knowledge and a positive attitude towards addressing weight management.

Perhaps more alarmingly, even third-year trainees, despite being trained in motivational interviewing techniques, also lacked specific knowledge and appeared rather unenthusiastic about providing lifestyle advice.

These attitudes most likely reflect the fact that their trainers were generally despondent about weight management and reported to have rarely observed long-lasting results. In fact, these teachers regularly warn their trainees not to have high hopes.

Tainers and trainees both feared ruining the relationship with their patients by bringing up the issue of weight management and rather preferred having patients enter evidence-based multidisciplinary treatment programmes. They also called for an image change in society to stop the epidemic.

The finding in this study (which I am sure are not just limited to Dutch trainees) are alarming, as they demonstrate that GP trainees are still leaving school without feeling any more competent in treating overweight patients than their trainers.

Under these circumstances, there is indeed little hope that the next generation of GPs will be any better prepared to provide evidence-based weight management advise to their patients than the current generation of GPs.

As the researchers point out, there is an urgent need for a drastic attitude change towards acquiring the competency and efficacy to provide evidence-based obesity treatments both amongst GP trainees and (perhaps even more importantly) amongst their teachers.

Indeed, no GP training program should be allowed to continue graduating doctors, who do not understand even the basics of weight management or do not see this as an important part of their medical practice.

Of course, there are numerous GPs, who are turning their attention to weight management and (as in the example cited above) are beginning to see considerable results in their patients.

If you have had a positive experience with your GP regarding weight management, I’d certainly love to hear about it.

If you are a GP offering weight management advise to your patients, let me hear whether you consider this a worthwhile effort or a waste of your time.

Arya M. Sharma is a Professor of Medicine at the University of Alberta who blogs at Dr. Sharma’s Obesity Notes.

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