“90% of the time it’s not just weight.” Barriers and facilitators to the implementation of obesity guidelines in general practice.

Problem

The prevalence of obesity in Australia is rising as it is internationally. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements of the guideline in general practice (only 22.2% of patients have their Body Mass Index and 4.3% have their waist circumference documented in their medical record). This study aimed to determine the barriers and enablers to implementation of obesity guideline recommendations in general practice by exploring the views of GPs, practice staff and patients.

Approach

We adopted a qualitative approach. Twenty GPs, 20 practice staff, and 40 adult patients participated in semi-structured telephone interviews. GPs and practice staff were recruited from clinics in the metropolitan Melbourne. GPs then recruited patients who had: a) a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease; b) a recorded BMI in the overweight (25-29) or obese (>30) range; and c) had attended for a consultation in the last 6 months. We utilised the Theoretical Domains Framework to develop the interview schedule. Interviews were audio-recorded and transcribed verbatim. Thematic techniques were used to analyse the data.

Findings

Addressing weight issues was challenging for GPs and practice staff, particularly doing so opportunistically and where GPs had poor knowledge of services to refer to. A professional sense of responsibility to patients was a strong motivator to carry out the recommendations. Personal weight issues were a concern for practitioners as was fear of losing patients or damaging existing doctor-patient relationships. Practitioners did not want to increase out of pocket expenses for patients or add to a patient’s existing burden when they already had significant comorbidity (e.g. mental health issues). Patients expressed uncertainty as to whether patients themselves or the GP should broach the topic of weight and inconsistent provision of information and resources. They described complacency regarding their weight, being unprepared to take up GP advice and having other health issues that took precedence. They commented that a strong GP-Patient relationship facilitated the occurrence of a conversation about weight management.

Consequences

Patient perspectives provide insights into the challenges of obesity management and complement the views of health professionals. These findings will help to inform the development of a complex intervention aimed at improving the implementation of obesity guidelines in general practice that will need to address both practitioner and patient barriers.