Talking about overweight and obesity in rural Australian general practice

Abstract

As many patients’ sole point of contact with the health care system, primary health care physicians (general practitioners [GPs] in Australia) are often positioned as key players in responding to rates of overweight and obesity in dominant public discourse. However, research from Western industrialised countries suggests that GPs may not be prepared for, or confident in, having conversations about overweight and obesity with patients. Little attention has been given to this topic in Australia, particularly in the context of rural health. The aim of this study was to understand how GPs in two rural settings in Victoria, Australia talk about overweight and obesity with patients. Working from a multidisciplinary perspective, a qualitative study design was adopted, and semi‐structured interviews were conducted with seven GPs and seven GP patients living in two rural communities between January and April, 2016. Data was coded manually and thematic analysis was used to explore the data. The findings of this study support the argument that, in contrast to dominant messages within public health discourses, GPs may not be best placed to act as the primary actors in responding to overweight and obesity as they are constructed in epidemiological terms. In fact, the perspectives of GP study participants suggest that to do so would compromise important dimensions of general medical practice that make it simultaneously a human practice. Instead, more balanced, holistic approaches to discussing and responding to overweight and obesity with patients could be taken up in local, interdisciplinary collaborations between different health professionals and patients, which utilise broader social supports. Focussing on long‐term, incremental programs that consider the whole person within their particular socio‐cultural environment would be a productive means of working with the complexities of overweight and obesity. However, structural level changes are required to ensure such initiatives are sustainable in rural practice.

‘It's not just to treat everybody the same’: A social justice framework for caring for larger patients in healthcare practice

“…For participants, integrating social justice into clinical practice meant understanding individual health behaviours related to weight and otherwise as bounded by broader social conditions, while recognising that people had situated agency to improve their wellbeing in the face of external challenges. These findings align with prior research by Malatzky and Glenister (2019), who found that GP participants eschewed dominant individualistic approaches to weight. Unfortunately, research shows that the personal responsibility for health discourse still exerts power on larger patients, who experience self‐blame because of their weight status (Lewis et al., 2011; Thomas et al., 2008).…”

Barriers to obesity health care in general practice from rural Waikato GP perspectives: A qualitative study

“…This was associated with not offending patients due to the stigmatised nature of obesity. These findings share similarities with previous literature both urban practice based 22,24 and rural practice based 34,35 which identify barriers to include time constraints, avoiding offensive or stigmatising language, and the need to not jeopardise the therapeutic relationship. However, this study found additional barriers to communication that extend previous literature.…”

“…22,23,26,30,31 Some rural-only-based Australian studies indicated that GPs experience communication difficulties when discussing weight in general practice and face challenges when delivering obesity health care. 34,35 However, there is limited understanding of the weight management barriers faced by rural GPs in NZ, specifically, in the rural Waikato region which has a significant Māori population. 36 While the Clinical Guidelines for Weight Management (CGWM) in adults 11 indicates that GPs are positioned as best suited to manage obesity in their clinical practice, obesity is still a major health concern indicating there could be barriers within this space hindering weight management efforts.…”

“…Perceived barriers to obesity health care in general practice are ineffective conversational strategies, stigmatisation of obesity, the extent of a GPs role or responsibility with obesity management, and system limitations 22,23,26,30,31 . Some rural‐only‐based Australian studies indicated that GPs experience communication difficulties when discussing weight in general practice and face challenges when delivering obesity health care 34,35 . However, there is limited understanding of the weight management barriers faced by rural GPs in NZ, specifically, in the rural Waikato region which has a significant Māori population 36 .…”

In it for the long haul: the complexities of managing overweight in family practice: qualitative thematic analysis from the Health eLiteracy for Prevention in General Practice (HeLP-GP) trial

“…The term family practice is used in this publication as this term has wider recognition from an international perspective. Participants attending primary care view their family medical practitioner (FP) and family practice nurse (FPN) as having a key role in managing obesity [ 4 , 5 ]. We know from previous research however that within this setting weight, body mass index (BMI) and waist circumference (WC) are infrequently assessed [ 6 – 8 ], and opportunities to provide comprehensive weight management advice is often missed [ 6 – 8 ].…”