General Practice Trainees Remain Unenthusiastic About Managing Obesity
Thursday, February 3, 2011
Given the staggering prevalence of overweight and obesity in most developed countries, there is no other hope than to have general practitioners (and their allied health colleagues) take on the considerable burden of managing obesity in their practices.
In fact, a recent example of a successful weight management program run in primary care just found considerable media attention in local newspapers.
But research shows that most general practitioners (GPs) neither feel confident nor effective in managing excess weight in their patients, and many would rather not bring up the topic of weight management at all.
So what about GP trainees? After all, the next generation of GPs will have little choice but to devote a considerable proportion of their time and practice to dealing with weight-related health issues.
This question was now addressed by Jochemsen-van der Leeuw and colleagues from the University of Amsterdam, in a paper just published in Family Practice.
For this study, the researchers conducted focus groups of first- and third-year Dutch GP trainees and their teachers regarding their attitude, willingness, and ability to provide lifestyle interventions for overweight patients.
First-year GP trainees clearly lacked both knowledge and a positive attitude towards addressing weight management.
Perhaps more alarmingly, even third-year trainees, despite being trained in motivational interviewing techniques, also lacked specific knowledge and appeared rather unenthusiastic about providing lifestyle advice.
These attitudes most likely reflect the fact that their trainers were generally despondent about weight management and reported to have rarely observed long-lasting results. In fact, these teachers regularly warn their trainees not to have high hopes.
Tainers and trainees both feared ruining the relationship with their patients by bringing up the issue of weight management and rather preferred having patients enter evidence-based multidisciplinary treatment programmes. They also called for an image change in society to stop the epidemic.
The finding in this study (which I am sure are not just limited to Dutch trainees) are alarming, as they demonstrate that GP trainees are still leaving school without feeling any more competent in treating overweight patients than their trainers.
Under these circumstances, there is indeed little hope that the next generation of GPs will be any better prepared to provide evidence-based weight management advise to their patients than the current generation of GPs.
As the researchers point out, there is an urgent need for a drastic attitude change towards acquiring the competency and efficacy to provide evidence-based obesity treatments both amongst GP trainees and (perhaps even more importantly) amongst their teachers.
Indeed, no GP training program should be allowed to continue graduating doctors, who do not understand even the basics of weight management or do not see this as an important part of their medical practice.
Of course, there are numerous GPs, who are turning their attention to weight management and (as in the example cited above) are beginning to see considerable results in their patients.
If you have had a positive experience with your GP regarding weight management, I’d certainly love to hear about it.
If you are a GP offering weight management advise to your patients, let me hear whether you consider this a worthwhile effort or a waste of your time.
AMS
Edmonton, Alberta
Jochemsen-van der Leeuw HG, van Dijk N, & Wieringa-de Waard M (2011). Attitudes towards obesity treatment in GP training practices: a focus group study. Family practice PMID: 21273284
Thursday, February 3, 2011
We know that 95% of people are unable to lose and more importantly keep off excess weight. Some evidence shows that yo-yo dieting can actually produce more negative mental and physical consequences for individuals than maintaining a steady (albeit heavy) weight. We know that although there is a huge stigma attached to being heavy, our society encourages people to eat copious amounts of junk food and the only people we see exercising are those who are already superfit or those being tortured on Village on a Diet or the Biggest Loser. We know that people are so squeezed for time that making meals at home (almost always the healthier option) and finding time to simply take a half-hour walk daily is virtually impossible for many people.
And then experts ask why trainee GPs are uncomfortable or not interested in dealing with overweight patients?
Dr. Sharma, we need a societal revolution and nothing short of that. First, we need to stress HAES (health at every size), which means encouraging people to eat more unprocessed (or minimally processed) food and moving their bodies on a regular basis in a ways that are comfortable to them. It means getting rid of the word “diet”, and debunking once and for all the validity of the BMI. It means accepting that health comes in a wide variety of shapes and sizes, though it rarely comes accompanied by a Big Mac or a scooter to get around the store.
Young doctors are no different from anyone else in society: they have just as many prejudices (“you’re fat: that means you’re lazy and eat too much junk food”) and fears (“I’m fat and although I’m not lazy nor do I eat a lot of junk food, everybody’s going to think I do”) as anyone else. How can we expect them to take on this impossible task, given the state of the science (abysmal: no one actually knows how to help people achieve their own personal healthy weight and then maintain it without severe psychological and physical stress and restriction) and the stigma attached to overweight?
Instead of teaching students a negative concept (“overweight is intrinsically BAD”), perhaps they might react better to the positive concept of health at every size.
Thursday, February 3, 2011
Dr. Sharma,
I love this post. You bring a much more valid argument to my blog post about my personal experiences with GP’s regarding my morbid obesity http://diaryoffatdad.blogspot.com/2011/02/iatrophobia-fear-of-doctors.html
As an obese individual there is nothing comfortable about going to the doctor and if the GP’s have attitudes similar to your post there is a good chance we wont’t feel comfortable enough to ask the questions we need too or even describe what ails us because we are ashamed. GP’s need to create an environment of understanding where every patient can get the advice or guidance they need. In my blog I mention that I have been obese my entire life, I have seen hundreds of doctors for various reasons and not once was my weight brought up as a concern and I have never recieved any guidance. I know there are many great doctors out there on the right track but for the time being, many of us obese individuals are left in the dark.
Thursday, February 3, 2011
This is a obvious problem. Here in the US, we lack any formalized training in weight management. For those of us involved in Obesity management, it has been on the job training. So unless the trainees are at established teaching centers with available resources, the blind will lead the blind. In my own practice, we insure that all students have a good working knowledge of energy metabolism and behavioral strategies. We are fortunate enough to have the available resources so the students know what to offer. If nothing is available, nothing is offered. The typical advice (ELEM: eat less exercise more) is unacceptable. Needless to say, both the trainer and trainee must be sincere, and motivated, certainly not an easy task. Major work will be needed on this one.
Thursday, February 3, 2011
I have never received meaningful help from my MD. MD’s and dietitians always trot out the BMI chart. I don’t need a chart to tell me i am fat. Also MD’s and dietitians trot out Canada’s healthy eating chart but can never explain how much fruit and vegetables to eat to help reduce weight in a sensible manner.
What i have learned about compulsive overeating has come from Weight Watchers. And i give full credit to Weight Watchers because they know and understand more about obesity then MD’s and dietitians.
Skinny people never understand how or why a person become obese.
Thursday, February 3, 2011
This just confirms the need for the medical community to embrace Alberta Health Services Weight Wise Community Network and other non-medical resources. It’s really hard to get your attention unless we’re from the medical community. I say let the people who have the passion for weight and wellness (skinny or otherwise, who have done their due diligence) show what we can do.
Thursday, February 3, 2011
I’ve accompanied friends who have kidney disease or have diabetes, to their hospital tests, treatments, and diet seminars for their conditions.
They have to deal with “severe physical and physiological stress and restriction”.
When I feel like complaining about my diet and walking program for obesity , I figure at least it’s not dialysis, and at least I don’t have to get needles, and at least weighing myself is easier than testing blood for sugar levels.
Friday, February 4, 2011
In response to Anonymous,
I believe life-long food restriction (aka dieting) or the feeling that one should be food restricting creates a constant state of stress that is extremely unhealthy for both body and mind.
I feel for your friends who are dealing with stressful medical conditions (having had some myself, I am far from personally devoid of experience in this area), but this does not diminish the unhealthy stress of the diet mentality.
Friday, February 4, 2011
Unfortunately, your post is all too true in the US as well. Because the focus is on weight loss instead of sustainable healthy lifestyle changes (which may result in weight loss), most approaches focus on the what, not the how. That is the critical missing piece; no wonder doctors are discouraged by the lack of results.
In your post yesterday, Why Men and Women Gain Weight, the problem clearly isn’t lack of knowledge. The US just released the Dietary Guidelines for Americans 2010 and again made the fatal flaw of focusing on the what not the how: http://www.eatwhatyoulovelovewhatyoueat.com/2011/02/how-do-the-dietary-guidelines-2010-fit-with-mindful-eating.html
When I speak to Family Medicine Residents and Medical Students at the American Academy of Family Physicians National Conference in July, I’ll describe the necessary paradigm shift toward fearless and mindful eating (described here http://www.eatwhatyoulovelovewhatyoueat.com/2009/09/are-you-open-to-a-paradigm-shift-in-weight-management-.html).
It is going to take a revolution – but then nothing important happens any other way!
Saturday, February 5, 2011
“These attitudes most likely reflect the fact that their trainers were generally despondent about weight management and reported to have rarely observed long-lasting results.”
Can any of the trainers give us evidence for the long-lasting results of statins in any but a select few of the millions prescribed this toxic drug class? They can’t. Yet they will continue to prescribe. There is no systemic training to practice medicine in our pharma controlled medical schools. Rather, noob physicians are being trained to be drug pushers.
Saturday, February 5, 2011
Dairy of…I suggest you go in with a wasted look, long unkempt hair and carrying a Fender.
Of course I’m being facetious. But rock musicians with deadly addictions are treated better than people with food addiction.
Saturday, February 5, 2011
I had an interesting conversation with two physicians doing clinical research and training medical students. I told them how improving my diet in my twenties improved my eyesight. I had to get new, weaker glasses three times, and my night vision improved dramatically. The American got irritated. The Indian said, “Of course. You had a vitamin A deficiency in your childhood.”
If American physicians are so despondent about diet that they cannot respond positively when it does work, how will they ever encourage people to improve? I see researchers working on obesity drugs making fun of the obese in their talks. I see the sarcasm toward diet in the trainers. The trainees can’t help but pick it up. I hope they work under the Indian for a good long time.
Monday, February 21, 2011
These young doctors are right, and I hope that the next doctor I see is one of them. I have trouble believing DiaryofFatDad, because I’m not “morbidly obese,” (just the regular kind), I’ve gotten a weight lecture every time I’ve gone to a doctor since I was seven, they don’t believe me when I tell them that I already exercise and eat a healthy diet, and they consider me non-compliant when I tell them that I don’t plan to go on a “weight loss plan.” (hey if I start with the dieting, maybe I’ll yo-yo up to 400 pounds like my aunts – brilliant idea, doc!)
This is why I only go in for a checkup once every five years. If I could find a doctor who never mentioned my weight and didn’t make assumptions about my habits based on it, but instead straightforwardly ran routine tests and treated any problems that came up, I would be ecstatic.