This study is novel in its attempts to determine why there are so few consultations for weight management when more than 60% of the population is overweight or obese. The BEACH study of Australian general practice activity indicates that less than 1% of GP consultations are primarily for weight management when the country is facing an obesity crisis [4]. This study also attempts to evaluate if there is a difference between patients' perception of the GP's role and the GP's activeness in bringing up weight during the consultation if the patient has already has an obesity related disease.
The results of this exploratory study may indicate a general acceptance of larger body size and attitudes from both patient and doctor and that addressing weight and losing weight may still be a topic that is not brought up in medical consultations despite the obvious negative health effects. This may also be a result of lack of communication between patient and doctor or a lack of weight management skills and confidence by the doctor.
One of the issues that may be highlighted is that of those in the sample that the GP did tell to lose weight, only 10% did not have any established cardiovascular obesity related co-morbidities but were obese. Yet, it is well established that reducing weight is an effective primary prevention strategy of many diseases [1–3, 12, 13] and that the direct cost of obesity to the economy has been said to be $2.4 billion a year and the indirect costs as high as related $9 million [14]. It can be postulated that GPs can contribute to reducing this burden by preventing the development of these diseases as opposed to acting when the disease is already present. Yet, this study indicates that GPs are reluctant to bring up weight during consultations unless they had an associated illness. This was supported by similar studies which found that less than half of obese adults reported being advised to lose weight by their GPs and that communication about weight was only targeted to patients with higher BMIs and obesity-related co-morbidities [1, 6–9].
Another possible reason for the low number of consultations with GPs for weight management is that patients do not have confidence in their GPs, despite more than two thirds stating that believed that GPs have a role. A number of studies from the USA [6–11] and overseas [12, 13] indicate that patients were disappointed with primary care weight management and wanted substantially greater effective involvement by their GPs [7–10]. Similarly, this study shows that less than 20% of patients would actually bring up their weight in the consultation. The fact that many cardiovascular obesity related co-morbidities such as hypertension, hypercholesterolaemia, diabetes, heart disease and strokes encompass a wide range of medical specialities and allied health providers, emphasises the need for a team approach. As this study shows that patients prefer personal trainers and dieticians above medical practitioners (GPs, surgeons, physicians) as managers of weight, there is obvious benefit in establishing a multi – disciplinary approach for weight management which may involve partners and family, allied health and medical practitioners. There appears to be no established facility in Australia that embraces this approach for overweight and obese patients who do not have an existing disease.
It appears that there is a reluctance in both parties to discuss weight management in GP consultations. There is certainly a mismatch between the urgency to address the obesity epidemic and the creation of interventions based in primary care. With international studies [8–12] also indicating a lack of confidence in GPs' ability to manage weight, perhaps education should be targeted at GPs to improve their weight management skills and knowledge. A first step would be to evaluate GPs' perception of their overweight patients and also to research their confidence and ability to manage obesity.
Consequently, there has been much discussion regarding an urgent need to improve the standards of obesity management in primary care [15–17]. A survey done by 756 Australian GPs in 2000 indicated that they thought the prevention and management of obesity needs addressing [16]. Effective communication skills, particularly for sensitive issues such as weight, may need to be improved in GPs so that they may improve their confidence in discussing weight issues with patients. Many GPs also cite lack of time, training, resources, staff support, adequate reimbursement and fear of negative patient reactions as common reasons why they fail to treat obesity effectively [7, 8, 16–18]. The establishment of a team approach to obesity may be one way to address this problem. The Counterweight Project, a UK based primary care weight management has shown some promising results and may used as a model [19].
This study's limitations include not investigating factors such as motivation, and the impact of other illnesses as a contributing factor to the low consultation rate. Also, this was a small sample involving only three general practices and the findings may not be generalised to a wider population. The study needs to be extended to other GP practices including those in the rural community for confirmation.