Seventy percent of the physicians disagreed that body weight should be decreased in obese patients only. This ratio was 55.1% among pediatricians.
This approach was influenced by the doctors’ own BMI. Although many agreed that weight reduction was expected not only from obese patients, only 46.7% of doctors with BMI over 30 kg/m2 had the same opinion (p = 0.007). The mean age of those who agreed was significantly higher (56.2 ± 0.9 years vs 53.7 ± 0.6 years, p = 0.019).
Attitude
The GPs’ different personal attitudes, bias and preconceptions were explored by using the questionnaire. Willingness and self-confidence were quite different as well (Table
3).
Table 3
GPs’s attitudes concerning obesity and obese persons and distribution of answers in this domain
GP’s role is to refer overweight or obese patients to other professionals rather than attempt to treat themselves | 83.7 | 16.3 |
GPs should be models and maintain normal weight | 11.2 | 88.8 |
I feel well-prepared to manage overweight and obese patients | 43.4 | 56.6 |
Treating overweight and obese patients is professionally gratifying | 29.5 | 70.5 |
Obese patients are lazier and more self-indulgent than people with normal weight | 32.1 | 67.9 |
Overweight patients are lazier and more self-indulgent than people with normal weight | 34.4 | 65.6 |
Only a small percentage of overweight and obese people can lose weight and maintain this loss | 20.4 | 79.6 |
The mean age of those who believed obesity could be managed in primary care without sending all obese patients to specialists was lower (53.7 ± 0.5 years vs 58.4 ± 1.1 years, p = 0.04).
Ninety-four percent of doctors in the normal BMI category agreed that family physicians should be an example in body weight, while only 80.8% of obese doctors gave the same answer (p = 0.004).
Treating obesity means a higher professional satisfaction for doctors having board qualification in family medicine only compared to others who are more qualified (76.8% vs 67.6%, p = 0.038).
The belief that “Obese patients are lazier and more self-indulgent than people with normal weight” was supported by 52.6% of obese and 67.9% of non-obese doctors (p = 0.01). The mean BMI of those doctors who agreed was 25.5 ± 0.21 kg/m2, while it was higher (26.5 ± 0.4 kg/m2) among those who disagreed (p = 0.026). This belief regarding patients in the overweight category was supported by 54.8% of obese doctors and 65.8% of those who were categorized with lower BMI (p = 0.036). Doctors who agreed with this statement were older (55.1 ± 0.5 years) than those who disagreed (52.7 ± 0.8 years, p = 0.024).
Practice
The diagnostic, treatment and consultation practices were not uniform. Anthropometric parameters related to obesity as diagnostic tools were considered differently (Table
4).
Table 4
Diagnostic practice, advice given and tools used by GPs in the management of obesity with the distribution of answers in this domain
Weight without reference to height | 54.9 | 45.1 |
BMI calculation | 20.9 | 79.1 |
Waist / hip ratio | 44.4 | 55.6 |
Waist measurements | 34.9 | 65.1 |
Comparison with ideal weight | 30.2 | 69.8 |
Appearance | 77.9 | 22.1 |
Weight management advice and tools
| | |
Eat less during meals | 12.9 | 87.1 |
Eat less fat | 10.2 | 89.8 |
Don’t eat between meals | 23.3 | 76.7 |
Eat less sugar | 6.7 | 93.3 |
Eat more fruits and vegetables | 3.7 | 96.3 |
Consume fewer caloric drinks | 5.3 | 94.7 |
Definitely avoid specific foods | 31.0 | 69.0 |
Follow personalized low-calorie diet (1200–2200 kcal/day) | 17.0 | 83.0 |
Follow very low calorie diet (<1200 kcal/day) | 72.9 | 27.1 |
Follow commercial /advertised diet | 96.2 | 3.8 |
Exercise /sport | 6.4 | 93.6 |
Do more exercise in everyday life (e.g. walking, gardening) | 4.4 | 95.6 |
Leaflets on healthy behavior | 41.5 | 58.5 |
Food diary | 40.3 | 59.7 |
Nutritional education | 32.8 | 87.2 |
Diagnostic methods based only on inspection were accepted less frequently by physicians qualified in family medicine only, than by doctors having two board examinations (16.1% vs 24.8%, p = 0.049).
The diagnosis of obesity based only on body weight measurement was made more frequently by doctors who treated only adults, than by family pediatricians (49.3 vs 32.8, p = 0.045).
BMI-based diagnosis was higher in cities (84.7%). It was only 71.2% in the capital and 74.3% in villages (p = 0.002).
Waist circumference was considered more frequently in pediatric than adult practices (79.1% vs 63.3%, p = 0.046). It was preferred by doctors qualified in family medicine only compared to those who had acquired more board qualifications (71.8% vs 61.7%, p = 0.035). Physicians working in the capital relied on waist circumference measurements rarely in comparison with doctors in other settings (57.0% vs 66.1%, p = 0.038).
Waist/hip ratio was calculated in 49.8% of adult and 64.2% of pediatric practices (p = 0.026). It was less commonly used in the capital than in other of settlements (43.6% vs 54.3%, p = 0.027). Older doctors realized its importance better than their younger colleagues did (56.2 ± 0.6 years vs 52.1 ± 0.7 years, p = 0.002). Doctors having board specialization / qualification in family medicine only regarded this approach more important than their colleagues with two qualifications (58.8% vs 50.5%, p = 0.038).
Differences were found in the mean age of doctors accepting self-reported body weight data from patients and those who insisted on weighing their patients (55.3 years vs 51.8 years, p = 0.002). This practice was significantly higher in the capital (p = 0.023).
Body weight measurements in underwear instead of outdoor clothing was preferred by older (55.6 years vs 53.7 years, p = 0.03) and underweight physicians and but fewer obese doctors followed suit (68% vs 37.5%, p = 0.04). The number of board examinations, being a resident, location and number of enrolled patients had no influence on this difference in the applied methodology.
Strict reduction in fat intake was emphasized by 86.0% of male and 92.9% of female physicians (p = 0.020) when giving nutritional advice. Eating (having a snack) between two main meals was prohibited more frequently by doctors with more qualifications (83.3% vs 74.9%, p = 0.044). They also recommended personalized low-calorie diet more frequently (83.3% vs 74.9%, p = 0.044). The doctors’ mean age preferring this type of diet was higher than that of their colleagues who did not (57.5 ± 0.7 years vs 53.2 ± 0.6 years, p = 0.014). Age was a significant contributor for agreeing to avoid some energy-dense dishes (55.2 ± 0.5 years vs 52.3 ± 0.9 years, p = 0.004). Dietary advice was provided less frequently in the capital than in other settlements (57.3% vs 67.8, p = 0.026) and also less frequently by more qualified doctors (63.4% vs 74.3%, p = 0.015). The mean age of doctors realizing the importance of dietary counseling was higher than that of those who did not (55.3 ± 0.6 years vs 52.7 ± 0.9 years, p = 0.010).
Doctors provided very different data about the achieved weight reduction of their obese patients following dietary counseling. No relation was found between the characteristic of practitioners and reported initial decrease in body weight, expressed in percent of the baseline weight. These date served a basis for qualitative factorial (cluster) analysis.
The theory and suspected reasons of developing obesity were discussed with the patients more frequently by female care providers than male physicians (64.6% vs 44.1%, p = 0.018). Fifty per cent of the residents also discussed this topic.
Ninety-three percent of the GPs recommended weight reducing programmes routinely. This figure was lower (83.0%) among family pediatricians. Doctors having a higher number of enrolled patients (above 1.600) provided dietary advice in a lower ratio (p = 0.06). Phone interview with patients, to monitor their achievement in weight reduction was used by 22.8% of GPs.
Personalized physical activity programmes were recommended by only 32.6% of the physicians. Female doctors consulted significantly longer with their obese patients and consultations were significantly shorter in practices with a higher number of enrolled patients (means: 12.1 vs 9.6 minutes). These figures were 10 vs 6 minutes by residents, respectively.
The vast majority of the doctors (96.3%) let their patients know about the expected changes in body weight. The recommended change in body weight within 6 months was 9.3 ± 6.6 percent of baseline body weight.
Following a diet recommended and advertised in the media was supported more frequently by male physicians (6.8% vs 2.5 %, p = 0.038), while their female colleagues quite often asked their patients to keep a record of the food they had consumed (64.8% vs 51.9%, p = 0.009).