MANAGING OBESITY

Difference in Paradigms Between Health Care Practitioners and Patients in Managing Obesity

Difference in paradigms between health care practitioners and patients in managing obesity

Introduction

The prevalence of people who are overweight and obese is rapidly increasing in the Western world. There are many health risks and associated comorbidities including hypertension, diabetes, ischemic heart disease, gallstones, osteoarthritis and malignancy.

The Israeli health and nutrition national survey detected a disturbingly high prevalence of obesity in the year 2000. In the age group of 25?65 y, 44% of men and 32% of women were overweight (body mass index (BMI) 25?30 kg?m) and an additional 17% of men and 25% of women were obese (BMI>30 kg?m).

Methods

We administered an anonymous questionnaire to FPs participating in continuing medical education (CME) programs affiliated with all academic departments of family medicine throughout Israel. Questionnaires were distributed during the CME sessions conducted throughout the academic year of 2000. All participating physicians were actively providing direct patient care during the survey period. The survey was distributed in CME classes, with no incentive to the participants, and collected during the same session, so as to maximize respondents' compliance. A significant proportion of all Israeli FPs participate in the CME courses. Three main groups of Israeli FPs take part in CME courses. The first group consists of board-certified family physicians (BCFPs). They tend to be younger than the other groups receiving CME. Those in the second group (non-BCFPs) are older and more experienced. They are not board-certified in family practice, as they typically began primary care practice before the formal residency program came into existence. The third group consists of residents in family medicine training. They are required to participate in CME as part of their training.

This survey focused on physician attitudes and knowledge regarding obesity. The questionnaire was developed and validated in a focus group of family physicians. The study questions are divided into three sections.

Section 1

This section consists of questions concerning physicians' approach to obese patients and methods used to achieve patients' weight reduction. For example, the doctor was requested to answer: do you advise your patients to increase physical activity as part of a weight reduction scheme?

Other issues in this section included sources of knowledge and ways to update this knowledge. Answers to the statements on this section were on the scale: 'usually', 'sometimes' and 'rarely'. Only the answers of 'usually' were considered as 'yes'

Section 2

This section contains questions concerning physicians' attitudes toward obese patients. Physicians reported their attitude toward statements such as 'Obese people lack motivation and lack willpower' or reasons why obese people want to lose weight. Answers to the statements on this section were 'agree' or 'disagree'.

Section 3

Respondents also provided demographic and professional information such as age, gender, years in practice and professional status.

Statistical analysis

The survey responses were entered into the Excel for Windows database and analyzed in SPSS for Windows. We used descriptive statistics to analyze the responses to each item. Further statistical analysis was conducted to determine the existence of associations between respondents' demographic and professional characteristics ...