"Dietitians May Only Have One Chance"-The Realities of Treating Obesity in Private Practice in Australia.

Claudia Harper,Radhika V Seimon,Judith Maher,Amanda Sainsbury

doi:10.3390/healthcare10020404

Claudia Harper, Radhika V Seimon + Show 2 more

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https://doi.org/10.3390/healthcare10020404

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Abstract

Introduction: Overweight and obesity are the leading contributors to non-fatal burden of disease in Australia. Very low energy diets (VLEDs) comprising of meal replacement products (MRP) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. Dietitians in private practice are perfectly placed to administer treatments for obesity; however, little is known about the preferred interventions used or their attitudes to incorporating VLEDs and MRPs into their treatments for overweight and obesity. Methods: This study used descriptive qualitative methods to explore accredited practicing dietitians’ (APDs’) perspectives and practices regarding obesity and obesity interventions, including the use of VLEDs and MRPs. Qualitative in-depth semi-structured interviews were conducted with 20 dietitians who had experience in private practice and in treating obesity. Transcribed interviews were analysed thematically using the technique of template analysis. Results: In the context within which dietitians’ practice was found to be a barrier to using evidence-based practice (EBP) for obesity treatment, four overarching themes were found. These were: (1) patient-centred care is the dietitians’ preferred intervention model; (2) VLEDs promote weight loss in specific situations; (3) systemic barriers constrain effective dietetic practice and equitable access to all, and (4) successful outcomes are predicated on working outside of systemic barriers. Conclusion: Dietitians in private practice are well placed and able to provide life-enhancing and evidence-based treatments for overweight and obesity and associated chronic disease in the community. However, systemic barriers need to be addressed to provide equitable access to effective care irrespective of socio-economic status.

Highlights

Introduction published maps and institutional affilThe prevalence of overweight and obesity has reached epidemic proportions around the world [1,2]
The dietitians in this study were a mixture of specialist and generalist, but all had experienced working with obesity and chronic disease in some capacity
The dietitians in this study revealed several key obstacles that interacted with each other in a way that made intervening in obesity and overweight, including the use of Very low energy diets (VLEDs) and meal replacement products (MRP), frustrating

Summary

Introduction

Introduction published maps and institutional affilThe prevalence of overweight and obesity has reached epidemic proportions around the world [1,2]. Obesity-associated co-morbidities and healthcare costs are ever increasing [2,3]. Health Survey showed that two thirds (67.0%) of Australian adults have overweight or obesity (12.5 million people), an increase from 63.4% in 2014–2015 [4]. Overweight or obesity is a known risk factor for 22 high-cost diseases including diabetes, musculoskeletal conditions (e.g., osteoarthritis and back pain), cardiovascular disease, kidney disease, sleep apnoea, asthma, dementia and various cancers [4,5,6]. Moderate weight loss is known to reduce blood pressure, Type 2 diabetes biomarkers, circulating lipids, and other CVD risk biomarkers, as well as, sleep apnoea and hip/knee osteoarthritis [7]. To combat rising chronic disease, secondary to overweight and obesity, the Australian government provides Medicare rebates under the Medicare Benefits Scheme (MBS).

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