The 5As team patient study: patient perspectives on the role of primary care in obesity management

Abstract

BackgroundOver 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients’ perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies.MethodsQualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta.ResultsFour illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities.ConclusionsPatients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to “eat less, move more”. Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

“…As such, it is essential to explore the impact of adverse experiences prior to the onset of weight gain on eating habits, physical activity, social life, and emotional reactions. Furthermore, listening to patients’ experiences and tailoring the best possible intervention programs has also been recommended as best practice [9, 26]. The results of our study nevertheless underscore the importance of psychological evaluation in the presurgical assessments of patients with morbid obesity and indicate that adverse life experiences might play a role in the patients’ treatment choice for obesity.…”

“…Nevertheless, BMI and DM2 remain the predominant predictors of bariatric surgery as obesity treatment [8]. The importance of building healthy therapeutic relations between patients and healthcare providers was demonstrated in a recent study that assessed patient perspectives in the role of primary care in obesity management [9]. Also, another recently published study revealed divergence in perception and attitudes between patients with obesity and HCP’s perspective of obesity treatment [10].…”

Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study

“…Employers in the ACTION Study Canada and United States reported greater efficacy of their companies' wellness programs than did PwO; however, the wellness programs were not necessarily specific to obesity management. Understanding the attitudes of Canadian HCPs, PwO and employers towards obesity management is critical for overcoming barriers that prevent PwO from seeking and receiving support and medical treatment; fostering a workplace culture that recognizes and treats obesity as a chronic disease; and generating strategies and new delivery systems to improve collaborative, evidence‐based and patient‐centred care …”

“…Over past decades, the scientific understanding of obesity and its associated complications has led to obesity being increasingly recognized as a chronic disease requiring long‐term management . However, barriers exist to the optimal management of obesity in healthcare systems, including deep‐rooted weight bias, common misperceptions about the complexity and chronic, relapsing nature of obesity, lack of training among healthcare providers (HCPs) and the use of non‐evidence‐based recommendations . Given the significant and growing impact of obesity on Canadians, it is important to understand perceptions and behaviours, both of people with obesity (PwO) and HCPs, in order to optimize management of this disease.…”

Dietitians' perspectives on patient barriers and enablers to weight management: An application of the social‐ecological model

“…In terms of enablers, having ongoing support from health professionals and being able to attend community programs were seen as important enablers. While patients’ lack of motivation was a barrier highlighted in the present study and in other studies, research evaluating patients’ perspectives on weight management revealed that accountability to health professionals was perceived by patients as a way of maintaining their motivation …”