The Embededdness Of Obesity And Why It Matters

Current obesity guidelines and professional educational activities, often assume that patients actually go to see their doctors for help with their weight issues.

It turns out that this is not exactly what happens in actual clinical practice – indeed, patients with excess weight almost never go to see their doctor specifically for this reason.

Rather, patients primarily go to their doctors for help with any of the many health conditions associated with obesity – problems ranging from high blood pressure and diabetes to sleep apnea, arthritis or infertility.

In other words, obesity rarely presents as a discreet health problem – rather, it is “embedded” in other health issues.

This is the (perhaps, when you think about it, not quite so surprising, ) finding of a study by Asselin and colleagues from the University of Alberta, published in Clinical Obesity.

The 5As Team study was designed to create, implement and evaluate a flexible intervention to improve the quality and quantity of weight management visits in primary care.

To gain a better understanding of current practice, we conducted semi-structured interviews with 29 multidisciplinary team providers and field notes of intervention sessions.

A key pattern that emerged from the thematic analysis of the data was that patients do not present, nor do healthcare providers usually address obesity as a primary focus for a visit. Rather, obesity is generally “embedded” in a wide range of primary care encounters for other conditions.

This finding has important implications for clinical practice.

For one, when patients present to their health care provider with a specific problem, be it diabetes, sleep apnea, or knee pain, they want their provider to discuss their diabetes, sleep apnea or knee pain – they are not interested in hearing about their weight issues.

On the other hand, when providers see patients presenting with diabetes, sleep apnea or knee pain, it already uses up all their limited time to talk about diabetes, sleep apnea or knee pain, so tagging on a meaningful discussion of weight is simply not feasible.

These observations suggest that obesity treatment approaches and tools that assume a discreet weight management visit are doomed to fail, as they do not represent or fit into the current way of practice.

On a positive note, the embedded nature of obesity management can potentially be harnessed to leverage multiple opportunities for asking and assessing root causes of obesity, and working longitudinally towards individual health goals (as laid out in the 5As framework).

Thus, for providers it may be as simple as tactfully and non-judgementally (after first discussing the primary problem) asking if the patient has concerns or would also like to also discuss their weight issues – if yes, this should prompt the booking of a separate and discreet appointment with a focus on discussing this problem, rather than simply throwing out some advice (“eat-less-move-more”).

For people struggling with their weight reading this, the lesson is that if you want your health professional’s help in addressing your weight, then book a specific appointment for exactly that, rather than trying to have a meaningful discussion about this when you happen to be there for something else.

@DrSharma
Edmonton, AB