Hindsight: Recognition and Management of Obesity in Primary CareSaturday, July 14, 2012
In 2004, we published the results of a study in the International Journal of Obesity, looking at recognition and management of overweight and obese patients in primary care settings across Germany.
The goals of this study were to examine (1) the point prevalence of overweight and obesity in primary care patients, (2) prevalence patterns in patients with high-risk constellations (diabetes, hypertension, cardiovascular disease, etc.), (3) doctors’ recognition and interventions, as well as patients’ use and perceived effectiveness of weight-loss interventions and (4) factors associated with non-treatment.
This cross-sectional study included 45,125 unselected consecutive primary care attendees recruited from a representative nationwide sample of 1912 primary care practices across Germany.
While almost 40% of all primary care attendees were overweight, 20% were obese.
Rates for overweight and obesity were highest in patients with diabetes (43.6 and 36.7%) and hypertension (46.1 and 31.3%).
Rates of overweight/obesity increased steadily by the number of comorbid conditions.
Doctors’ recognition of overweight (20-30%) and obesity (50-65%) was low, and patients’ actual use of weight control interventions even lower (past 12 months: 8-11%, lifetime: 32-39%).
Co- and multimorbidity were predictors for better recognition of obesity but did not appear to have a noticeable influence on the use of any weight-loss interventions.
Thus, back in 2004, this representative sample of German primary care patients showed a high prevalence of overweight and obesity but primary care management of excess weight was largely non-existent.
The key factors for this lack of intervention was predominantly due to doctors’ poor recognition of patients’ weight status, doctors’ inefficient efforts at intervention, patients’ poor acceptance of such interventions, and general dissatisfaction with existing life-style modification strategies.
It is probably fair to say that in the past eight years probably not much has changed and a similar study today will likely produce very similar results.
As in 2004, doctors today, are probably no more vigilant or enthusiastic about recognising and managing obesity than back then.
According to Google Scholar, this paper has 63 citations.
Saturday, July 14, 2012
That’s because they’re all missing that the emperor has no clothes. It’s obvious to people “uneducated” and some who are, but apparently it’s all magic and rocket science to the alleged experts. They are inefficient at leaning ‘hard enough’ to get patient ‘compliance’ with diets because the diets are completely unworkable and heavily focused on low-fat, high-carbs, and worse, emphasis on grains which are in great part an actual drug and a huge source of chronic inflammation directly and indirectly. Even when people are compliant it often doesn’t work for them (if they didn’t have insulin/carb intolerance issues and grain reactions, often they wouldn’t be fat in the first place) and they’re assumed to be lying. Or it’s simply not sustainable and leads to even more health problems (the weight goes down a little, bad cholesterol goes up). The medical industry is never going to be able to “implement and get compliance with the answer” when what they think is the answer is so retarded.
Sunday, July 15, 2012
I agree that the “interventions” doctors recommend don’t actually work long term for most people. In fact, they’re counterproductive. People who restrict their eating for weight loss tend to become heavier, not lighter, in the long term. I suspect that if doctors and patients are ignoring BMI in Europe, then that might be part of the reason why Europeans, on average, are not as heavy as Americans. Less yo-yo dieting = less long term weight gain.
Monday, July 16, 2012
In my experience as GP you are in 2012 still correct by putting “The key factors for this lack of intervention was predominantly due to doctors’ poor recognition of patients’ weight status, doctors’ inefficient efforts at intervention, patients’ poor acceptance of such interventions, and general dissatisfaction with existing life-style modification strategies. It is probably fair to say that in the past eight years probably not much has changed and a similar study today will likely produce very similar results. As in 2004, doctors today, are probably no more vigilant or enthusiastic about recognising and managing obesity than back then.”
Maybe the doctor’s weight and life style himself is also a key factor ?? 🙂
Otherwise, we need a different obesity management in primary care and really, your 5A’s program is very inspiring, but it willt take time and “credit points” to implement this in an European primary care practice …