Prise en charge de l’obésité : quel est le niveau de formation des médecins généralistes du département de la Haute-Vienne et comment perçoivent-ils leur pratique ?

Introduction

Obesity is a public health problem affecting in France at least one person in seven over 15 years. General practitioners (GPs) play a major role in the management of this chronic disease, but little is known about their level of education and their modalities of care in front of obese patients. The main objectives of the study were to assess knowledge and practices on obesity of the GPs in a French department.

Methods

An anonymous declarative questionnaire was sent to a sample of 200 GPs of the Haute-Vienne department. The questionnaire noted epidemiological data on GPs, asked their level of education and knowledge on obesity, assessed their modalities of care, their difficulties facing this disease and their proposals for improvement.

Results

Exactly 40.5% of GPs gave answers. 19.5% of their patients were obese. 23.5% of GPs have been educated on nutrition. A percentage of 76.6 of GPs detected obesity with BMI at a threshold ≥ 30 kg/m². A percentage of 96.3% were involved in the care of their obese patients, and 70.0% in partnership with a specialist. Only 12.8% of GPs proposed an association between the three modalities of treatment: dietary intervention, higher physical activity and psychobehavioral care. Precisely, 27.7% of practitioners used medicaments and 21.0% protein diets. Bariatric surgery had already been used by 60.8% of GPs. Several difficulties noted were already known, but they particularly pointed out the lack of reimbursement for dietetic visit. The main suggestions were to improve networking, to promote a better education of patients and their families, to obtain a special coding for obesity visits and better psychobehavioral care.

Conclusions

The management of obese patients is an important part of GPs’ activity. Their care habits are broadly consistent with recommendations for the diagnosis of obesity and weight loss goals. However, few practitioners are trained in nutrition, resulting in a high use of specialists and a low proportion of GPs managing their patients in a full-recommended manner. One of the main suggestions of GPs is to work on obesity with a better-structured environment.     

Practice Nurses' and Health Visitors' knowledge of obesity assessment and management

Background Obesity is increasing in prevalence in the UK. Practice Nurses (PNs) and to a lesser extent Health Visitors (HVs) may advise patients/clients on weight management. The aim of this survey was to examine HVs and PNs knowledge concerning the assessment and management of obesity by use of a questionnaire.
Method A postal questionnaire was sent to 35 HVs and 49 PNs based at 24 practices within one regional health authority. The practices had participated in a previous survey. A 54% (17 HVs and 28 PNs) response rate was achieved.
Results Responses indicated that little education concerning obesity had been received since professional registration, and a need for this was identified. Most respondents used a computer or chart to calculate BMI of patients/client. Three HVs and 21 PNs correctly identified that a BMI of > 29 or 30 indicated obesity, and six HVs and 21 PNs identified that centrally distributed obesity is associated with a greater risk of metabolic disease. Most respondents indicated they would advise a person with obesity to follow a low-fat diet; however, a low-energy diet was indicated by some. The majority were able to identify which of a number of foods were high in fat, although some low-fat foods were frequently misclassified. Most respondents mentioned the importance of lifestyle change and physical activity. Recommended weight loss generally followed current guidelines.
Conclusion Recommendations for practice are outlined. These include closer liason with dietetic services, more emphasis on the assessment of eating habits and lifestyle, greater use of a client-centred approach and use of appropriate guidelines on physical activity. Further research should be carried out to explore the results of this small-scale study.     

Dietary advice, nutritional knowledge and attitudes towards nutrition in primary health care

The high priority of health promotion within primary health care in the UK is evidenced through the acceptance, by the primary health care team (PHCT), of a contractual responsibility for health promotion, including the provision of dietary advice. This study sought to investigate the level of advice given on dietary matters, the methods used to give this advice and the nutritional knowledge and attitudes towards nutrition of Sheffield PHCTs; general practitioners (GPs) and practice nurses (PNs) were compared. All active practices ( n = 100) on Sheffield Health Authority's GP practice lists were invited to participate. A total of 58 interviews in 46 practices were completed, representing a response rate of 46%. Information was collected using an interviewer-administered questionnaire. Data analysis was carried out using MINITAB (Minitab Inc., Pennsylvania, USA); differences between groups were tested using the x² test.
It was found that PNs gave dietary advice more frequently than GPs ( P <0.05). GPs were more likely ( P <0.05) to give verbal advice only, whereas PNs tended to take a dietary history and to give both written and verbal advice. GPs were less likely than PNs to give comprehensive advice for type II (maturity onset) diabetes, hypercholesterolaemia and obesity. There were appreciable gaps in the nutritional knowledge of both groups. The majority of GPs and PNs believed nutrition to be important in disease prevention and expressed a desire for nutritional teaching as part of their medical training. The primary health care team is in a prime position to give dietary advice, however, it is evident that there is a need for improved nutrition education and training in dietary counselling.     

Assessing patients' and GPs' ability to recognise overweight and obesity

Objective : To assess the ability of GPs and patients to recognise overweight and obesity, determine factors associated with accurate weight perception, and identify methods used by patients and GPs to manage patient overweight and obesity. Methods : Data were collected in a substudy of the BEACH research program (a continuous, randomised, national cross‐sectional survey of general practice activity in Australia). Results : Of 1,599 sampled adult patients, 31.5% were overweight, 23.7% obese and 4.7% morbidly obese. One in four (26.8%) overweight/obese patients (BMI ≥25.0) did not consider themselves overweight. There was an association between patient age and sex and accurate weight perception. Overweight/obese females and those aged 45–64 years were most likely to recognise their overweight. GPs correctly identified 60.8% of overweight patients, but underestimated 35.7% as normal weight. They also identified 60.0% of obese patients, but incorrectly categorised 37.0% as overweight and 3.0% normal weight. There was no association between GP age and sex and accurate weight perception. Conclusions : Patients' and GPs' perception of weight can often be inaccurate, with many not recognising overweight and obesity. Improvement in recognition of overweight and obesity may increase management and encourage early intervention to prevent disease associated with these weight problems.     

Overweight and obesity: knowledge, attitudes, and practices of general practitioners in france

OBJECTIVE: To describe the current knowledge, attitudes, and practices of French general practitioners (GPs) in the field of adult overweight and obesity management. RESEARCH METHODS AND PROCEDURES: A cross-sectional telephone survey interviewed a sample of 600 GPs, representative of the private GPs in southeastern France. A four-part questionnaire assessed personal and professional characteristics, attitudes and opinions about overweight and obesity, relevant knowledge and training, and practices (diagnostic methods, clinical assessments, weight loss objectives, types of counseling). RESULTS: Most GPs knew that weight problems are health-threatening, and 79% agreed that managing these problems is part of their role. Nevertheless, 58% did not feel they perform this role effectively, and one-third did not find it professionally gratifying. Approximately 30% had negative attitudes toward overweight and obese patients; 57% were pessimistic about patients' ability to lose weight; 64% often set weight loss objectives more demanding than guidelines call for; and neither food diaries nor nutritional education were used systematically. GPs' feelings of effectiveness and attitudes toward obese patients were associated with some professional (training) and personal (BMI, personal diet experience) characteristics. DISCUSSION: GPs' feelings of ineffectiveness may stem from an underlying conflict between practitioners' and patients' representations of weight problems and the relationship problems this causes. Inadequate practices and health care system organization may also play a role.     

A service evaluation to determine the effectiveness of current dietary advice in treating human immunodeficiency virus-associated weight loss and to highlight potential service improvements

Background: Weight loss and muscle wasting are experienced by many patients with human immunodeficiency virus (HIV) (Grinspoon et al., 2003). Malnutrition is an important predicator of morbidity and mortality; people who are malnourished who received antiretroviral treatment are six times more likely to die than those who are adequately nourished (Paton et al., 2006). The physical manifestations of muscle wasting can have significant psychosocial implications for HIV patients (Power et al., 2003; Sattler, 2003). The aim of this study to evaluate provision of dietetic care to patients referred for acute weight loss advice and identify areas for potential service improvement. Methods: The data were gathered from the departmental dietetic activity statistics in 2007, diagnosis code ‘HIV – acute weight loss’. Fifty‐nine cards were located and baseline weight, height and body mass index (BMI) were recorded (two female, 57 male). Qualitative data on dietetic intervention were extracted from record cards – little and often eating approach, food fortification (FF), high energy high protein oral nutritional supplement (ONS) prescribed. Data were collected on body image, exercise and weight at follow‐up visits during 2007. Results: Forty‐three percent of the patients referred for ‘HIV‐acute weight loss’ were lost to follow‐up. Forty‐seven percent of the remaining patients had a BMI <20 kg m^?2. Following their initial dietetic intervention, 81% of these patients had gained weight at the first follow‐up. All had received nutritional counselling on little and often eating approach and FF; 75% had ONS prescribed. Average weight gain with nutritional counselling alone was 1.3 kg (2.1 kg) and for nutritional counselling plus supplementation was 2.1 kg (1.8 kg). This represented 2.5% (4.1%) and 3.9% (3.4%) weight gain, respectively. Discussion: This evaluation has highlighted that patient follow‐up frequency is an area for service improvement. Fifty‐three per cent of patients (excluding those lost to follow up) had a BMI ≥20 kg m^?2 and were inaccurately recorded in the statistics as being referred for ‘HIV‐acute weight loss’. Fifty‐two percent of these patients reported lipodystrophy and body image concerns, similar to findings of other studies. Fifty‐six percent reported weight improvements following dietetic consultation. Body image is a frequent referral trigger, therefore improvements should be made to identify and treat patients with body shape issues. Conclusions: Dietitians are effective at achieving weight gain in HIV positive patients with a BMI <20 kg m^?2 using nutritional counselling methods with or without oral nutritional supplementation; these patients experienced a 3.3% weight gain. Strategies need to be implemented to reduce the number of patients lost to follow‐up, as weight loss is a key morbidity and mortality indicator in HIV. References Grinspoon, S. & Mulligan, K. (2003) Weight loss and wasting in patients infected with HIV. Clin. Infect. Dis. 36 (Suppl. 2): 69–78. Nerad, J., Romeyn, M., Silverman, E., Allen‐Reid, J., Dieterich, D., Merchant, J., Pelletier, V., Tinnerello, D. & Fenton, M. (2003) General nutritional management in patients infected with HIV. Clin. Infect. Dis. 36 (Suppl. 2): 52–62. Ockenga, J., Grimble, R., Jonkers‐Schuitema, C., Macallan, D., Melchior, J.C., Sauerwein, H.P., Schwenk, A. & Suttmann, U. (2006) ESPEN guidelines on enteral nutrition: wasting in HIV and other chronic infectious diseases. Clin. Nutr. 25, 319–329. Paton, N.I., Sangeetha, S., Earnest, A. & Bellamy, R. (2006) The impact of malnutrition on survival and the CD4 count response in HIV‐infected patients starting antiretroviral therapy. HIV Med. 7, 232–330. Power, R., Tate, H.L., McGill, S.M. & Taylor, C. (2003) A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals. Sex. Transm. Infect. 79, 137–141. Sattler, F. (2003) Body habitus changes related to lipodystrophy. Clin. Infect. Dis 36 (Suppl. 2): 84–90.     

A study of cardiovascular risk in overweight and obese people in England

Objectives: To report current levels of obesity and associated cardiac risk using routinely collected primary care computer data. Methods: 67 practices took part in an educational intervention to improve computer data quality and care in cardiovascular disease. Data were extracted from 435 102 general practice computer records. 64.3% (229 108/362 861) of people age 15 y and older had a body mass index (BMI) recording or a valid height and weight record that enabled BMI to be derived. Data about cardiovascular disease and risk factors were also extracted. The prevalence of disease and the control of risk factors in the overweight and obese population were compared with those of normal body weight. Results: 56.8% of men and 69.3% of women aged over 15 y had a BMI record. 22% of men and 32.3% of women aged 15 to 24 y were overweight or obese; rising each decade to a peak of 65.6% of men and 57.5% of women aged 55 to 64 y. Thereafter, the proportion who were overweight or obese declined. The prevalence of ischaemic heart disease, diabetes mellitus and hypertension rose with increasing levels of obesity; their prevalence in those who are moderately obese was between two and three times that of the general population. Systolic and diastolic blood pressure, blood glucose even in non-diabetics, cholesterol and triglycerides were all elevated in the overweight and obese population.

Conclusion: Based on the recorded data over half of men and nearly half of women are overweight or obese. They have increased cardiovascular risk, which is not adequately controlled by current practice.     

A rural/urban comparison of the roles of the general practitioner in colorectal cancer management

Objective: To identify and compare the roles of urban, rural and remote general practitioners (GPs) in colorectal cancer (CRC) management. Design: Semistructured interviews exploring GP views of their role in CRC management. Setting: Urban, rural and remote general practices in north Queensland. Participants: Fifteen GPs in urban, rural and remote practice. Main outcome measures: Self‐reported roles in the management of CRC patients and factors influencing these roles. Results: All GPs, regardless of location of practice, played a role in diagnosis, referral, postoperative care, psychosocial counselling, follow up and palliative care. Involvement in treatment of CRC patients was only performed by remote GPs. In general, rural and remote GPs played greater roles in care coordination, clinical and psychosocial care. Rural and remote GPs were more heavily involved throughout the entire illness progression when compared with their urban counterparts. Conclusions: The results of this study indicate that rural and remote GPs in north Queensland play a greater role than urban GPs in the management of CRC. In order to maintain and enhance the roles of rural and remote GPs in CRC care, appropriate guidelines and remuneration should be provided. Palliative care support might also be useful to rural and remote GPs.     

Canadian dietitians'' views and practices regarding obesity and weight management

OBJECTIVE: To provide insight into Canadian dietitians' attitudes and practices regarding obesity and weight management. DESIGN: Cross-sectional mail survey of a stratified random sample of members of Canadian dietetic associations. SUBJECTS: A total of 514 dietitians (74% of those surveyed), 350 (69%) of whom actively counselled overweight/obese clients. MEASUREMENTS: Participants received a questionnaire to assess dietitians' attitudes regarding obesity and overweight, views regarding their role in weight management, counselling practices, and the criteria used to judge success. Demographic variables were collected. RESULTS: Most dietitians believed that obesity contributes to morbidity and mortality, and that small weight losses produced important health benefits. However, 80% agreed that health indicators other than weight loss should be the focus of obesity management, and 55% specifically recommended that clients not weigh themselves. Instead, weight management was promoted by recommending healthy eating and increased physical activity. Three-quarters agreed that they are the profession best trained to manage obesity but two-thirds believed their time would be better spent preventing rather than managing obesity. Dietitians most valued education received from on-the-job support and mentoring from other dietitians. Participants reported wanting to learn more about motivational and behavioural modification counselling techniques. CONCLUSIONS: Canadian dietitians follow a lifestyle approach to weight management. Studies are required to formally assess the effectiveness of various aspects of this approach.     

Encouraging general practitioners to complete the four‐year‐old Healthy Kids Check and provide healthy eating and physical activity messages

Objective : To describe the impact of a training and support intervention to encourage completion of the Healthy Kids Check (HKC) by general practitioners (GP) or practice nurses (PN) and provision of brief advice on diet and physical activity. Methods : The intervention (June 2008 to July 2010) was delivered by Divisions of General Practice (DGP) in the Hunter New England (HNE) region of NSW, Australia, to members in 300 practices. Intervention impact was evaluated using Medicare data on the number of HKCs completed and a post‐intervention telephone survey of randomly selected parents in HNE and rest of NSW. Results : Training reached 31% of GPs (n～ 216/700) and 71% of PNs (n～320/450); 31% of four‐year‐olds received a HKC in HNE compared to 15% in NSW; 27% of HNE parents (n=162) reported a GP or PN had provided advice during their child's vaccinations visit compared to 15% of parents (n=154) in NSW (p=0.002). There was no significant difference in proportion of children who had weight or height assessed (55.6% in HNE and 54.6% in NSW). Conclusions : Boosting HKC claims and healthy eating and physical activity messages in general practice is feasible. More intensive strategies are required if obesity prevention and management benefits are to be achieved. Implications : General practice is an important but under‐utilised source of advice for parents and data for policy makers on childhood obesity in Australia.     

A survey of dietetic practice in obesity management

Introduction: Little is known about how dietitians organize the management of overweight and obese clients. The aim of this survey was to identify current dietetic practice in the management of such clients. Methods: In preparation for the joint Association for the Study of Obesity/British Dietetic Association (BDA) symposium in November 1997, a questionnaire was sent to BDA members registered on two BDA databases in order to identify current practice in the dietetic management of obesity. A total of 347 BDA members were contacted; 252 dietetic heads of service (or equivalent) and 95 members on the BDA freelance register. Information relating to referral criteria, organizational details and key features of typical management programmes was collected. Results: A poor response rate of 40% was achieved, with a similar response rate from dietetic heads of service and freelance dietitians. Of those who did respond, 91% accepted referrals for overweight or obese clients. The majority of respondents allocated up to 30 min for a new client appointment, and offered at least one follow-up appointment, usually at 4-week intervals and lasting up to 20 min. Freelance respondents allocated longer times for new client and follow-up appointments, and also reviewed patients more frequently (but did not allocate more follow-up appointments), than dietetic heads of service. Most consultations were on an individual basis and were not guided by standardized protocols. Conclusion: There is clearly an opportunity for dietitians to move towards evidence-based treatment of obesity, without substantial resource implications, by offering longer-term treatment using group therapy. The use of clinical guidelines, and auditing future dietetic practice against these guidelines, should be considered.     

Translational research — Implementation of NHLBI obesity guidelines in a primary care community setting: the physician obesity awareness project

Background: Greater than 65 percent of the United States (US) population is overweight, with 32 percent obese. It is a problem in both developed and developing nations. While guidelines exist, counseling by physicians about obesity and weight loss is inconsistent, and physician approaches to obesity management have limited success. This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity. Twenty-one physicians in a suburban, middle class population in the Midwestern United States participated.Methods: Physician obesity awareness, weight, height, BMI, blood pressure, lipids, and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up. All 21 physicians received academic detailing and were presented with their clinical outcomes. Ten physicians received an Enhanced Intervention. They were additionally asked to place a sticker in the chart of their overweight or obese patients.Results: Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline, decreasing to 0% at followup (p=0.041). Reference to obesity management by Intervention physicians increased from 2.4% to 9.2% (p=0.001) while for Enhanced Intervention physicians documentation increased from 3.9% to 15.6% (p=0.002). Those patients in the Enhanced Intervention group lost an average of 6.19 lbs (3.3%) (p=0.083) during the one year period versus 4.6 lbs (2.5%) (p=0.20) in the Intervention group. The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group. The data from both groups was pooled at both baseline and follow-up. The average weight of patients decreased from 185.7 lbs to 180.3 lbs (excluding outliers weighing >311 lbs). This 5.4 pound loss was significant (p=0.027). The BMI decreased from 30.1 to 29.1 (p=0.095). Cardiovascular co-morbidities improved.Conclusion: Obesity and overweight have a very high prevalence in a primary care community based settings. Clinicians are not comfortable diagnosing and managing obese and overweight patients. A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss.     

Impact of Obesity on Outcomes in Critically Ill Children

Purpose: To examine whether obesity confers a protective effect on critically ill pediatric patients, similar to what has been reported in critically ill adults. Methods: A retrospective cohort study including patients aged 2–18 years admitted to a 24‐bed pediatric intensive care unit from 2009 to 2014. Patients were divided into 1 of 3 weight categories: normal weight (body mass index [BMI], 5%–84.9%), overweight (BMI, 85%–94.9%), and obese (BMI ≥95%). Outcomes investigated included mortality, need for intubation, need for inotropic support, and duration of mechanical ventilation. Results: A total of 1817 patient encounters met inclusion criteria. There was no difference in Pediatric Index of Mortality 2 scores between groups. There was a significantly smaller percentage of overweight and obese patients requiring intubation (P = .003) and inotropic support (P = .031) compared with normal‐weight patients. Being overweight or obese was neither protective nor a risk factor for mortality with an adjusted odds ratio of 1.83 (confidence interval [CI], 0.82–3.85; P = .12) and 1.51 (CI, 0.70–3.12; P = .27) comparing the overweight and obese groups with the normal‐weight group, respectively. There was no difference in duration of mechanical ventilation between the normal‐weight and overweight and obese groups (P = .893 and 0.484, respectively). Conclusions: In critically ill pediatric patients, being overweight or obese was associated with decreased need for intubation and inotropic support compared with normal‐weight patients. However, being overweight or obese is neither protective nor a risk factor for mortality or duration of mechanical ventilation.     

“There’s always something else”: Patient perspectives on improving the implementation of obesity guidelines in general practice

ObjectivesThe prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice.MethodsQualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically.ResultsWhile a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems.ConclusionsIt is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.     

Experiences and expectations of the new genetics in relation to familial risk of breast cancer: a comparison of the views of GPs and practice nurses

BACKGROUND: Advances in genetics may change the practice of medicine in many ways. Ascertaining practitioners' perceptions about managing the risk of familial breast cancer can give an insight into the current and expected impact on general practice to inform relevant education. Little is known about the practice nurses' (PNs) views of the new genetics in comparison with those of the GP. OBJECTIVES: Our aim was to describe and compare the views of GPs and PNs on their experiences and expectations of the new genetics in relation to managing familial risk of breast cancer. METHOD: A questionnaire, assessing views on the current and future impact of genetic advances in general and on the management of women with a familial risk of breast cancer, was sent to all GPs and PNs in the 66 practices of the Cambridge and Huntingdon Health Authority. RESULTS: There was a 69% response rate. The words 'cautious', 'mixed feelings', 'hopeful' and 'optimistic' were used most frequently in response to views on genetic advances, but PNs chose more positive words than GPs (P < 0.001). PNs were also more optimistic than GPs in relation to the future positive impact of genetics on practice (P < 0.0001). Sixty-one per cent of GPs and 45% of PNs agreed that genetic advances in relation to breast cancer were already affecting their work. A minority of practitioners had attended recent educational events in risk assessment for breast cancer, and only 8% of GPs reported a practice policy on familial breast cancer risk management. CONCLUSIONS: GPs and PNs show a cautious optimism in relation to advances in genetics, with PNs most optimistic. Many perceive that genetic advances in relation to breast cancer are already affecting their workloads, yet educational attendance and practice policies are lacking. Given PN involvement, multi-professional education may be appropriate. Education about risk management, including family history and genetics, might be better integrated into more general teaching on the prevention and management of breast cancer, than taught alone.     

Weight management: what patients want from their primary care physicians

OBJECTIVE: The researchers wanted to determine the weight management experiences of patients in primary care, and what those patients want from their physicians. STUDY DESIGN: Patients completed a survey in a primary care waiting room. Afterward they were measured for body mass index (BMI). POPULATION: A total of 410 consecutive adult patients in 2 primary care practices at the University of California, San Francisco, were approached, and 366 (89%) completed the survey. OUTCOMES MEASURED: The primary outcomes were patient attitudes about weight loss, previous weight management experiences with their current physicians, and future preferences for weight management within the primary care relationship. RESULTS: Ninety-seven percent of the obese patients (BMI > 30), 84% of the overweight patients (BMI=25-30), and 39% of the non-overweight patients (BMI < 25) thought they needed to lose weight. Forty-nine percent of the obese patients, 24% of the overweight patients, and 12% of the non-overweight patients had discussed weight with their current physicians. The types of weight management assistance that patients most wanted from their physicians were: (1) dietary advice, (2) help with setting realistic weight goals, and (3) exercise recommendations. CONCLUSIONS: Although most patients believe they should lose weight, this is often not discussed during office visits. Most patients (especially those who are overweight or obese) want more help with weight management than they are getting from their primary care physicians.     

The role of oral health care professionals in preventing and managing obesity: A systematic review of current practices and perceived barriers

IntroductionThere is a growing interest to expand the role of oral health care professionals in obesity prevention and management. The aim of this systematic review was to synthesise the evidence on current practices of, and perceived barriers to, oral health care professionals’ involvement in obesity screening and management.MethodsKey search strings were developed and used in seven databases from inception through February 6, 2019. Data were screened against inclusion criteria, independently extracted, and quality appraised by two reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsTen studies were included in this review. The practices of oral health care professionals in relation to obesity assessment, counseling, and specialist referrals were found to be very limited. Oral health care professionals believed in their role to support patients for achieving weight-loss goals, however just over one-third were trained in anthropometry. Perceived barriers included lack of time, limited knowledge or training, patients’ unwillingness to listen to oral health care professionals’ advice, and lack of appropriate specialist referrals.ConclusionOral health care professionals are well-positioned and supportive in undertaking healthy weight interventions in their clinical practice; however, their practices are limited due to barriers such as lack of time, limited training and lack of referrals.     

Using simulated patients to develop doctors' skills in facilitating behaviour change: addressing childhood obesity

Medical Education 2010: 44 : 706–715 Objectives This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity. Methods Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5–9‐year‐old children rated GP performance during real‐life consultations. Other measures included child body mass index (BMI) Z‐scores (at baseline and at a 9‐month follow‐up) and GP‐reported levels of comfort and competence and the perceived value of SP visits. Results Simulated patient ratings, but not GP self‐ratings, of GP performance predicted both parent ratings of real‐life consultations (Spearman’s rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z‐scores between baseline and follow‐up (Visit 1, rho ? 0.45; Visit 2, rho ? 0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them. Conclusions Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes.     

Obesity among people with and without mental retardation across adulthood

OBJECTIVE: This study was designed to explore obesity during adulthood and the likelihood of moving out of obesity among 1809 adults without disability and 680 adults with mental retardation who received care at the same primary care practices during the period of 1990 to 2003. Research Method and Procedures: A retrospective observational design using medical records first identified patients with mental retardation (MR) and age-matched controls without disabilities. Data on BMI collected during each primary care visit allowed exploration of obesity at three levels. Moving out of obesity was defined as having a BMI <25 kg/m(2). We also abstracted data on age, sex, race, and other medical conditions. RESULTS: For adults 20 to 29 years of age, 33.1% of patients without disability and 21% of patients with MR had a BMI >30 kg/m(2). Between the ages of 50 and 59 years, 40.5% of the patients without disability and 35.2% of the patients with MR had a BMI >30 kg/m(2). Patients with mild MR had similar prevalence rates of obesity and patients with severe MR had significantly lower prevalence of obesity compared with the patients without disability through 50 years of age. Throughout the period from 20 to 60 years of age, between 15% and 40% of individuals with and without MR, who were previously obese, were not currently obese. DISCUSSION: Throughout the adult years, an increasing proportion of individuals with and without MR are obese. However, obesity is not a chronic state; many people transition back to a normal body weight.