Obesity and the prevention of cardiovascular morbidity: a primary care survey
Excess weight is associated with an increased incidence of cardiovascular disease (CVD), which remains the leading cause of death worldwide. Commonly, assessment of CVD risk is inaccurate and risk-factors are not controlled resulting in sub-optimal preventative interventions. Although guidelines suggest that CV risk should be assessed and that GPs should offer clinical management to obese people, there is little evidence outlining current primary care practice to prevent CVD in obese patients. Before prevention initiatives can be improved and put in place, current practice that aids the prevention of CVD in obese and overweight individuals needs to be identified.
The aim of this research is to explore the attitudes and opinions of GPs regarding the prevention of cardiovascular morbidity in at-risk overweight and obese individuals.
An on-line questionnaire was conducted which explored the attitudes and opinions of GPs regarding the prevention of cardiovascular morbidity in at-risk overweight and obese individuals, as well as exploring current practice and ideas for future practice to tackle this issue. Participants were recruited from members of the online network Doctors.net.uk
A nationally representative sample of 501 UK GPs, registered with the GMC, participated. Two-thirds of respondents were White (65%), male (61%), and partners in their practice (65%). All GPs used BMI to assess weight, with 49% using it as their sole method. However, only 64% considered it the most accurate method available. 74% and 49% of participants were confident they could identify an obese or overweight person, respectively, using visual assessment alone. The majority agreed it was important to discuss weight with obese and overweight patients, and almost all GPs had opportunistically weighed patients, especially those with additional weight-related co-morbidities. 96% agreed it was very important to prevent CVD in at-risk obese patients, and this fell within the remit of GP. However, 99% believed that other agencies should also be involved in the preventative effort. The majority considered the 5-year health check insufficient, with a variety of opinions regarding what the content/ format of preventative efforts should take. Most commonly, GPs provided general advice or leaflets to obese and overweight patients to help prevent CV morbidity. There was low engagement with prescribing behavioural interventions and practices rarely held preventative patient sessions or engaged with external initiatives, mainly due to time, staff and financial constraints.
Although most GPs agreed that discussing weight with, and preventing CVD in, at-risk obese and overweight patients was important there is a gap between attitudes and behaviour. Many utilise opportunities to weigh patients and offer advice, but due to time and financial constraints specific interventions are rare. If mortality and morbidity rates from CVD are to be reduced, innovative, multidisciplinary approaches are needed to improve the prevention efforts in this at-risk population