Br J Gen Pract. 2005; 55:750-4
Epstein L , Ogden J
Background
Due to the increased prevalence of obesity GPs now have a key role in managing obese patients.
Aim
To explore GPs' views about treating obese patients.
Setting
An inner London primary care trust.
Design of study
A qualitative study using semi-structured interviews.
Method
Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis.
Results
GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution for them and offering an understanding of the problems associated with being overweight.
Conclusion
GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within their professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.
Comment
We agree that standard anti-obesity drugs in themselves are ineffective in meeting patients expectations, although combined with a structural behavioural programme they can help with weight loss. Our philosophy is that the problem does not lie with the patient, but with the environment. Healthier Weight Centres medically supervised weight loss programmes are designed to help patients utilise this principle for successful weight loss and improved self confidence.
