Patients don’t think general practice is equipped to help them manage their weight. They may be right.
General practice should be a great place to help people manage their obesity – but do patients agree?
And can primary care, in its current funding morass, give the time that’s needed?
In a small new study from New Zealand, researchers led by Dr Kimberley Norman, a health researcher from the University of Waikato, interviewed 16 general practice patients from rural Waikato, asking them about their weight management experiences.
“Whilst primary care is positioned as suitable for delivering obesity healthcare, this study found that participants do not perceive general practice to be equipped to deliver this care,” Norman et al. wrote in their paper published in BMC Primary Care.
“Surprisingly, minimal discourse linked weight management to general practice or interventions and some explicitly highlighted they would not consider visiting their GP for weight advice.
“Many patients positioned general practice as unsuitable to deliver effective weight management healthcare, a perspective that contradicts the national health policy and clinical guidelines in the UK, America, Australia, Canada and NZ.”
For Dr Liz Sturgiss, a GP and researcher at Monash University, the results came as a surprise.
“The fact that people did not even mention general practice as a place to go for weight management assistance – that did surprise me,” Dr Sturgiss told TMR.
Dr Norman told TMR the aim of the project was to “find out patients experiences with weight management in general practice”.
“We thought most of the narratives were going to be around barriers within that space, and there were a few, definitely.
“But a lot of the discourse was focused around the kind of factors that were outside the scope of general practice that did impact their effectiveness to manage their weight.”
Dr Norman and colleagues identified four common themes from their interviews with patients:
- Inconsistent information around food dietary advice, with patients reporting mixed messages about calorific intake, types of diet, and accessing quality and reputable information
- Significance of holistic factors: “participants reported the need for a ‘holistic’ view of weight management that incorporated many aspects to weight management and ‘not just my diet’”
- Obesity health centre: participants reported a desire for tertiary, specialised weight management centres rather than going to their GP; “expectations on a single health professional to provide all the needs for weight management were low due to the variances of weight management needs”
- Education about healthy living, processed foods labelling, in schools, and lifestyle changes was seen as crucial by participants.
Dr Sturgiss told TMR that in Australia tertiary centres were only being accessed “for the pointy end of obesity management”, for bariatric surgery, for example.
“Our waiting lists are enormous and blowing out all the time,” she said.
Dr Sturgiss and colleagues published a narrative review of the effectiveness of weight management interventions delivered in primary care in 2022, finding that “behavioural weight management interventions for adults with obesity delivered in primary care are effective for weight loss and could be offered to members of the public”.
So is the Australian model of general practice in its current state fit for delivering effective weight management interventions?
“It’s hard to deliver in our current system,” said Dr Sturgiss, who has written previously on the subject.
Patients with chronic health conditions lasting more than six months can be supported with a chronic disease management plan and can be eligible for up to five allied health visits per year.
“This situation is clearly inadequate for effective obesity management when we consider the findings from our meta-analysis where at least 12 visits are required. Further, a 2021 Grattan report found that only 56% of allied health services were bulk-billed and each visit on average cost patients $55,” Dr Sturgiss and Dr Claire Madigan wrote in the MJA last year.
Adding to the confusion is a lack of current guidelines for obesity management.
“We haven’t had obesity guidelines in 10 years,” Dr Sturgiss told TMR. “The last ones were rescinded in 2013.”
A team from Deakin University is working on new guidelines, she said.
“GPs are attempting to support patients living with obesity while working in a system that has no contemporary clinical guidelines, is underfunded to provide effective care, and in which they are often trying to make it all work for patients without financial means where the prevalence of obesity is highest. It just isn’t possible,” Drs Sturgiss and Madigan wrote last year.
“We need system reform and change to provide effective and equitable obesity care in Australia.”
