Canberra Health Services, Canberra, Australia.
The Australian Prevention Partnership Centre, Sydney, Australia.
BMC Health Serv Res. 2021 Feb 2;21(1):111. doi: 10.1186/s12913-021-06089-w.
Health services have a clear role in the treatment of obesity and diseases linked to obesity but a less well-established role in prevention, particularly in hospital and community-based health services.
The aim of this research was to examine whether and how hospital and community-based health services incorporate adult obesity prevention into policy and practice. The case study setting was an Australian based health service. Grounded theory informed all aspects of the research including participant recruitment, data collection and data analysis. A systems approach guided the analysis of diverse perspectives, relationships and interconnections within the study context.
The prevailing paradigm within the health service is that obesity is a matter of choice. This dominant perspective combined with a disease focused medical model overly simplifies the complex issue of obesity and reinforces the paradigm which treats obesity as a matter of individual responsibility. A focus on individual change hinders health services from playing an effective role in obesity prevention and leads to unintended consequences, including increasing stigma.
Health service responses to obesity and its prevention compound the negative elements associated with obesity for individuals and are ineffective in creating positive change at individual or a societal level. An alternative systems-level approach is needed to align health service responses with contemporary approaches that address obesity prevention as a complex problem.
卫生服务机构在肥胖症及肥胖相关疾病的治疗方面发挥着明确的作用，但在预防方面的作用则不太明确，尤其是在医院和社区卫生服务机构中。
本项研究旨在探讨医院和社区卫生服务机构是否以及如何将成人肥胖预防纳入政策和实践。研究的案例地点设在澳大利亚的一个卫生服务机构。扎根理论指导着研究的各个方面，包括参与者招募、数据收集和数据分析。系统方法指导着对研究背景下的不同观点、关系和相互联系进行分析。
卫生服务机构中普遍存在的观点认为肥胖是个人选择的结果。这种主流观点加上以疾病为中心的医学模式过于简化了肥胖这一复杂问题，强化了将肥胖视为个人责任问题的观点。关注个体的变化阻碍了卫生服务机构在肥胖预防方面发挥有效作用，并导致了意想不到的后果，包括增加耻辱感。
卫生服务机构对肥胖及其预防的反应加剧了个人与肥胖相关的负面因素，并且在个人或社会层面上都无法实现积极的改变。需要采取一种替代的系统层面的方法，使卫生服务机构的反应与当代方法保持一致，将肥胖预防作为一个复杂的问题来处理。
