A Cross-Cultural Analysis of Physician Management of Obesity. Comparing the US, France, Israel and Japan: Little Interest and Little Success

Richard J Schuster

doi:10.4172/2167-1079.1000166

Abstract

Background: Obesity is a global health problem. Physicians are frequently engaged with overweight and obese patients. Obesity guidelines have been successfully implemented on a small scale, but generally physicians struggle to manage obesity effectively. Methods: In a web-based survey, primary care physicians in the United States (US), France, Israel and Japan, were asked how they manage cardiovascular risk factors. They were specifically asked how frequently they saw patients in follow-up for hypertension, hyperlipidemia and obesity. Results: Respondents (956) included 656 French, 198 Israeli, 45 Japanese, and 53 US physicians. Follow-up for obesity no sooner than 3 months was recommended, by 73% (US) and 79% (Israeli) physicians, whereas 67% of French and 66% of Japanese physicians recommended more frequent follow-up (3 months or less). Hypertension and hyperlipidemia was managed more aggressively, especially the US, Israel and Japan. Discussion: Obesity is an international concern, with rates increasing everywhere. The prevalence of obesity is high in the US and Israel and much lower in France and Japan. Chronic disease management is most effective with frequent follow-up. US obesity guidelines recommend frequent (often monthly) follow-up visits. US and Israeli physicians do not appear to be aggressive in managing obesity, whereas French and Japanese physicians report more effort to manage obesity. In the US, obesity management is not considered effective and physicians are uncomfortable attempting to manage obesity with their patients. In France especially, physicians have a more social relationship with their patients and seem oriented toward chronic disease management, including greater attention to lifestyle change. Conclusion: Obesity has been medicalized and is a profound problem internationally. The medical care system must address obesity management more effectively. Further studies are needed to understand how physicians manage obesity and new approaches should be promoted to improve the outcomes of obesity management.

Highlights

Obesity is a worldwide problem and one that is increasing in prevalence with serious consequences for the population
Further studies are needed to understand how physicians manage obesity and new approaches should be promoted to improve the outcomes of obesity management
We report on the difference in obesity management from that of other Cardiovascular Disease (CVD) risk factors including hypertension – High Blood Pressure (HBP) and hyperlipidemia

Summary

Introduction

Obesity is a worldwide problem and one that is increasing in prevalence with serious consequences for the population. In 1999, the US National Institutes of Health (NIH) created practice guidelines for obesity management by health care providers, including physicians and shortly after that a “Practical Guide” to encourage implementation of the guidelines [3,4]. Since their release, there has been little measurement of their implementation and little evidence of their success [5]. Obesity guidelines have been successfully implemented on a small scale, but generally physicians struggle to manage obesity effectively

Methods

Results

Discussion

Conclusion