Recipients’ and providers’ perspectives of obesity and potential barriers to weight management programmes in patients with Rheumatoid Arthritis (RA): a qualitative study

Abstract

BackgroundThe UK rheumatology community serves an ageing and ethnically diverse population, with a growing public health concern about obesity. Overweight and obesity contribute to 2.8 million preventable deaths annually. A raised Body Mass Index (BMI) in those with Rheumatoid Arthritis (RA) can have a significant negative impact on clinical outcomes. The aim of the study was to examine patients’ and providers’ perceptions of obesity and potential barriers to participation in a future weight management programme to contribute to an appropriate intervention design.MethodQualitative semi-structured interviews were carried out with 11 patients with RA and one focus group was held with 8 members of a multi-disciplinary team working in one Rheumatology outpatient clinic. Framework analysis (FA) contributed to the inductive thematic analysis, and was employed to assist with the identification of the emergent codes and final themes.ResultsThree core themes were ascertained from the semi-structured interviews: i) The psychosocial impact of living with RA and obesity, ii) Challenges of living with RA and obesity and iii) Considerations for future weight management programmes. The Focus group analysis also identified three core themes: i) Micro-dynamics between patient and provider, ii) The relationship between the provider and the host institution in relation to the development of a future weight management programme and iii) The social and political context of obesity as a public health concern.ConclusionPerceptions of obesity and weight gain and associated barriers to participating in weight management programmes, differ significantly between patients and providers. Patients, require a holistic approach to weight management by clinicians and the acknowledgement of the significant psychosocial impact of a dual diagnosis of RA and being overweight or obese. In contrast, providers seem reluctant to address weight increase with patients and require education and support at an individual and institutional level to integrate weight management into routine care.

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

“…Consistent with empirical evidence regarding the difficult and complex nature of sustainable weight loss (Norris et al, 2005;Shaw et al, 2006), this study highlighted patients' own personal appreciation of the complexity of weight loss. Such sophisticated perspectives of the multidimensional complexity surrounding weight have similarly been widely described by women with rheumatoid arthritis who are overweight (Colligan, Galloway, & Lempp, 2017), and patients within the UK (Henderson, 2015) (Morden et al, 2014). Consequently, and aligned with the perspectives of patients in the present study, individuals who self-identify with overweight emphasize a need for psychological and emotional support from healthcare providers (Henderson, 2015;Rand et al, 2017) that extends beyond lifestyle advice.…”

“…Consistent with empirical evidence regarding the difficult and complex nature of sustainable weight loss (Norris et al, ; Shaw et al, ), this study highlighted patients' own personal appreciation of the complexity of weight loss. Such sophisticated perspectives of the multidimensional complexity surrounding weight have similarly been widely described by women with rheumatoid arthritis who are overweight (Colligan, Galloway, & Lempp, ), and patients within the UK (Henderson, ) and the US (Owen‐Smith, Donovan, & Coast, ; Puhl, Himmelstein, Gorin, & Suh, ) healthcare systems who are overweight or obese. Findings from a sample of patients with knee pain in the UK highlight pain and life‐long eating habits as particularly relevant to the complexity of weight management (Morden et al, ).…”

Rural Family Medicine Clinicians' Motivations to Participate in a Pragmatic Obesity Trial

“…10,11 Prior research shows a gap between physician and patient perspectives on weight loss counseling, perceived health impact of weight, motivation to lose weight, and perceived barriers to weight loss. [12][13][14] In addition, physicians can feel unenthusiastic about weight management for a variety of reasons, including lack of time to devote to counseling, lack of evidence-based treatment options, and a perception that it is not their responsibility as the physician. [15][16][17] For primary care physicians that practice in rural areas, these frustrations may be particularly acute.…”