Abstract
Two-thirds of UK adults do not have an up-to-date weight record in primary care. Some studies suggest that doctors do not raise the topic of weight management for fear of causing embarrassment or offence, or are doubtful whether people will make changes. However, for people with weight-related long-term conditions, conversations with general practitioners (GPs) can be crucial. Our study explores how people with long-term conditions associated with overweight recall and interpret conversations about weight in British primary care. An experienced qualitative researcher interviewed 41 people aged <42years with long-term conditions associated with overweight. A maximum variation sample was sought, and transcribed interviews were analysed thematically. We revealed that patients with weight-related long-term conditions have different experiences and expectations about the role of GPs in supporting weight management. If a GP did not raise weight management in the context of the long-term condition patients formed the impression that their overweight was not seen as "doctorable" that is, as an appropriate topic for the consultation, rather than a personal or "lifestyle" concern. This was explained in multiple ways, which are captured in two themes; perceiving weight as "doctorable"; and weight doctoring in primary care. The findings highlight the need for increased attention on weight-related long-term conditions in primary care. Interventions from GPs would be welcome if conducted in a sensitive, non-judgmental manner and based on sound evidence about what works.
Highlights
While we focus on people's experiences with general practitioners (GPs), we reference the wider multidisciplinary team who are involved in primary care weight management
Our analysis suggests inconsistencies in how GPs support people with weight-related long-term conditions to manage their weight
This was explained in multiple ways, which are captured in two themes; perceiving weight as “doctorable”; and weight doctoring in primary care
Summary
In a recent survey of people with overweight, only 20% of the 1309 participants had sought GP care in relation to their weight.[7] There are many potential reasons why this is the case, including the possibility that patients do not regard weightmanagement as a “doctorable” problem.[10] Patients may be reluctant to engage in conversations about weight if they anticipate that it will involve stigmatizing language and be overfocused on diet and lifestyle change.[11] Despite evidence of effectiveness,[12] GPs do not routinely engage in weightmanagement discussions.[1] Health professionals report embarrassment and concern about offending patients who are overweight, and some are unconvinced that people who are overweight will successfully make changes.[8,11,13] A recent review concluded that discussions about weight management are not a high priority for GPs.[14] surely GPs should not feel reluctant to raise the topic when the patient has a known, weight-related long-term health condition? Surely GPs should not feel reluctant to raise the topic when the patient has a known, weight-related long-term health condition? It is this specific group that is the focus of the interview study reported here
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