What German General Practitioners Believe About ObesityWednesday, July 21, 2021
Like most doctors, German docs are not particularly knowledgeable about the rather complex biology and psycho-sociology of obesity. However, they do appreciate that obesity is an important health problem, very much relevant to their practice.
So how do they feel about it and, perhaps more importantly, what are they doing to address it?
This question was examined in a recent qualitative study by Julian Wangler and Michael Jansky from the University of Mainz, published in the European Journal of Clinical Practice.
For their study, the researchers conducted interviews with 36 German general practitioners about their attitudes, behaviours and strategies towards patients with obesity.
Based on their analysis of the interviews, four types of physicians were identified.
Type 1 were those they described as “The Resigned” – these were doctors who had essentially given up and placed the blame squarely on the shoulders of their patients. Interviewees in this group went as far as to emphasise that obesity was ‘not a disease like any other’, but rather due to character predisposition involving living to excess or the ‘urge to let themselves go’. They viewed interventions as largely futile, mainly because patients were unwilling to take responsibility. Years of frustration with these patients has led them to doubt whether general practitioners can manage this type of patient effectively. Instead, they see a role for specialists using drugs, psychotherapy or possibly surgery as the final option.
Type 2, called “The Instructors” were doctors who attributed obesity largely to a combination of life circumstances and predisposition, and viewed structured exercise and diet programmes for their patients as delivering the best results. These doctors were often connected to a network of exercise and dietary practitioners resources in the community to which they could refer their patients. However, rather than providing continuous patient consultation at close intervals, they encouraged a ‘focussed and concentrated jump-start’ to ‘set the scenes for consistent and gradual weight loss’ in an individually matched motivational exercise programme. This group of doctors appreciated the use of health apps but was vehemently opposed to the use of medications or surgery, due to the risk of ‘yo-yo effects’.
Type 3, called “The Motivators”, were likewise opposed to the use of medication or surgery, but did have a far more favourable view of people living with obesity than “The Resigned”. Not only did they recognise the importance of sensitive communication and a collaborative approach to the doctor–patient relationship, but also felt that it is essential to provide enough time for consultation and remain accessible, even with treatment setbacks. Interviewees in this group had sometimes undergone additional training in psychotherapy and psychoanalysis and believed that this knowledge played a valuable role in successful long-term obesity management.
Type 4, “The Educators” were a mix between Type 2 and Type 3, but placed their bets on the importance of prevention rather than treatment. Although they provide support and care, this group was far more sceptical as to the success of treating obesity once it was established. Rather, they saw it as best to intervene early and to take regular health check-ups as an early warning system very seriously. Some in this group had undergone further training in nutritional medicine. For this group, the issue of medication or surgery did even not come up.
Irrespective of their “Type”, there was a general sense that ‘successful obesity patient management was often time-consuming, requiring a high level of medical commitment with new attempts at treatment after previous attempts had failed.’ Furthermore, all interviewees decried the severe lack of supporting structures and care services for preventing obesity and managing treatment in primary care.
While this categorisation of primary care practitioners with regards to attitudes and approaches toward obesity management is very informative (if not unexpected), it should concern us that none of these groups appear convinced of the need for or the effectiveness of medications or surgery. Rather, they appear stuck in a world where behavioural or “lifestyle” approaches (with varying levels of motivational, educational, psychological,and community support) are still viewed as the most effective treatments for this chronic disease.
This not only reflects their individual professional and perhaps personal biases toward obesity and people living with obesity, but also highlights the fact that we still have a long way to go before medical treatments including medications and surgery become the accepted mainstay of obesity management, similar to other chronic diseases for which such treatments exist.