Are general practitioners ready and willing to tackle obesity management?

Summary

Objective

To investigate general practitioners’ (GPs’) knowledge, role perception, confidence and practices of managing adult and childhood overweight and obesity, and to explore the association with GPs’ attendance at Continuing Professional Development (CPD) on overweight and obesity.

Methods

In 2007, all GPs in seven Divisions of general practice in New South Wales were sent a questionnaire on GPs perceptions and practices of weight counselling.

Results

646 GPs participated (40% response rate). About half of the GPs (47%) believed that only a small percentage of adults could reduce weight and maintain that loss, whereas 33% had a similar belief in relation to children. Most GPs believed that it was their role to manage weight and felt confident to do so with adults, but fewer GPs felt confident in managing children. Nevertheless, just over one-third of GPs reported they counselled more than 10 adult patients, and a similar proportion counselled more than 3 children per week. GPs who felt more confident were more likely to counsel adults (OR = 2.69, p = 0.001) and children (OR = 3.31, p < 0.001). Those who received CPD were more likely to feel confident in managing adults (OR = 1.56, p = 0.031) and children (OR = 2.19, p < 0.001).

Conclusions

Although the majority of GPs believe that weight management is their role, only a small proportion regularly provided counselling. This may partly be the result of GPs confidence in managing patients, especially children. CPD on overweight and obesity may benefit GP confidence, but additional training is needed to improve GP's counselling behaviour, particularly for children.

Introduction

Recent surveys showed that around one in two Australian adults and one in four Australian children are overweight or obese [1], [2]. General practitioners (GPs’), patients and the wider community believe that GPs can play a key role in managing obesity and other risk factors for chronic disease [3], [4], [5]. To support this role, several countries, including Australia, have developed clinical practice guidelines for the assessment and management of overweight and obesity [6], [7], [8].

In 2000, a study on GPs attitudes and practices on overweight and obesity management in Australia reported that many GPs felt they had an important role in obesity management and prevention, and that 70% and 58% of GPs found themselves well prepared to manage overweight and obesity, respectively [9].

Nevertheless, studies consistently show that GPs do not routinely assess patients’ weight status or provide advice on related lifestyle risk factors [10], [11], [12], and that there are significant barriers, such as absence of reimbursement arrangements, referral options, consultation time and perceived efficacy [9], [13], [14]. There have been considerable efforts to promote GPs’ role in providing assessment and advice in relation to smoking, nutrition, alcohol and physical activity risk factors amongst adults, through new tools, training programs and Medicare funded health checks [15], [16]. Despite the high political and media profile of obesity in recent years, far fewer programs or resources to support GPs in addressing weight status in adults or children have been developed or funded [9], [17].

Because of the rising prevalence of overweight and obesity in Australia, and associated chronic diseases, it is important to monitor the capacities and practices of GPs in addressing this. There are limited data on whether GPs are giving overweight and obesity equal or greater attention among their adult or paediatric patients, although the latter have been recognized as presenting particular challenges [3]. The current study investigated GPs’ knowledge, role perception and confidence to discuss adult and childhood overweight and obesity with patients, and the relationship between these factors and the extent to which this issue was actually addressed in patient consultations. The contribution of Continuing Professional Development (CPD) on overweight and obesity to GP confidence and frequency of discussing overweight and obesity was also examined.