The TabOO team (from left) Professor Tony Dowell, Lesley Gray, Rachel Tester and Dr Maria Stubbe.
New University of Otago research highlights the difficulties for GPs of discussing obesity with patients who are overweight and signals the need for resources to support them and other community health providers in this role.
Obesity is overtaking tobacco smoking in New Zealand as the leading potentially modifiable risk to health with obesity rates for adults third highest among Organisation for Economic Co-operation and Development (OECD) countries, behind the United States and Mexico. International obesity guidelines recommend that health professionals opportunistically encourage weight management with their patients.
Lead researcher of the TabOO research group (Talking about Overweight and Obesity) Lesley Gray, from the University of Otago, Wellington, says this new study shows GPs do engage in opportunistic discussions about weight. The topics of weight or weight management were raised mostly once or twice in a consultation and sometimes up to six times. However, there was evidence that such discussions are challenging and interactionally delicate.
“The delicacy of initiating talk about weight was evident in our video analysis of GP consultations, affirming that GPs do not wish to risk offending their patient or creating imbalance in their doctor-patient relationship.”
For example, fewer doctors would ask a question like: “Have you put on a bit of weight?”, instead, they were more likely to ask a question like: “weight-wise, where do you think you're at?”.
“By avoiding a question of statement that directly or explicitly referred to the patient being overweight, GPs opened up a face-saving 'escape-route' if the patient proved to be resistant to pursuing the discussion,” the research paper recently published online in the Journal of Primary Health Carestates.
Up until now, no New Zealand studies have examined actual general practice consultations to identify strategies employed to discuss weight in context of health issues. The University of Otago researchers analysed 36 video-recorded consultations in general practices from a sample of 205 recorded interactions.
Founding member and co-director of the Applied Research on Communication in Health (ARCH) group, Dr Maria Stubbe, says the most notable way of achieving a constructive dialogue was for the GP to relate the topic of weight to the patient's presenting clinical problems. Another common strategy was to include weighing the patient as a routine part of the physical examination.
Mrs Gray says the high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight.
The TabOO team has developed an online tool with prompts for health professionals concerning food, activity, behaviour and support. They are currently working with Compass Primary Healthcare Organisation in Wellington to see how the tool is utilised in routine consultations to support conversations around health and weight.
Other University of Otago staff involved in the research team were: Lindsay Macdonald, Rachel Tester, Jo Hilder and Professor Tony Dowell.
The video recordings used in this study were drawn from a permanent research archive of audiovisual data – the ARCH Corpus of Health Interactions. This material was collected in the course of several previous ARCH group studies supported by grants from the University of Otago, the Royal New Zealand College of General Practitioners, the Royal Society of New Zealand's Marsden Fund and the New Zealand Health Research Council.
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