Abstract
BackgroundControl of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research.MethodsDatabases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention.ResultsThe evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals’ views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice.ConclusionsThis review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.
Highlights
Control of obesity is an important priority to reduce the burden of chronic disease
In this research we present a review of published literature investigating the role of hospital and community based health services in adult obesity prevention
Perceptions and beliefs towards obesity prevention in health services This review found that along with practical barriers to changing practice including a lack of time, resources or clinical guidelines [34, 38, 39, 49], a key barrier to healthcare based obesity prevention is the perceptions and beliefs of health professionals towards obesity
Summary
Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. Chronic diseases place a significant burden on the Australian healthcare system They account for 90% of all deaths [1] and significantly reduce quality of life [2]. The World Health Organisation (WHO) highlights prevention of obesity as an important priority to reduce the impact of non-communicable disease. Both supporting people who are currently overweight to attain modest weight loss as well as preventing further increases in weight may eventually see a decrease in overall rates of obesity and a reduction in the rates of chronic diseases [6] and a decrease in associated costs [7]
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