Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, USA.
Clin Obes. 2021 Oct;11(5):e12471. doi: 10.1111/cob.12471. Epub 2021 Jun 4.
Two-thirds of UK adults do not have an up-to-date weight record in primary care. Some studies suggest that doctors do not raise the topic of weight management for fear of causing embarrassment or offence, or are doubtful whether people will make changes. However, for people with weight-related long-term conditions, conversations with general practitioners (GPs) can be crucial. Our study explores how people with long-term conditions associated with overweight recall and interpret conversations about weight in British primary care. An experienced qualitative researcher interviewed 41 people aged <42 years with long-term conditions associated with overweight. A maximum variation sample was sought, and transcribed interviews were analysed thematically. We revealed that patients with weight-related long-term conditions have different experiences and expectations about the role of GPs in supporting weight management. If a GP did not raise weight management in the context of the long-term condition patients formed the impression that their overweight was not seen as "doctorable" that is, as an appropriate topic for the consultation, rather than a personal or "lifestyle" concern. This was explained in multiple ways, which are captured in two themes; perceiving weight as "doctorable"; and weight doctoring in primary care. The findings highlight the need for increased attention on weight-related long-term conditions in primary care. Interventions from GPs would be welcome if conducted in a sensitive, non-judgmental manner and based on sound evidence about what works.
三分之二的英国成年人在初级保健中没有最新的体重记录。一些研究表明，医生担心引起尴尬或冒犯，或者怀疑人们是否会做出改变，因此不会提出体重管理的话题。然而，对于与体重相关的长期疾病患者来说，与全科医生（GP）的对话可能至关重要。我们的研究探讨了与超重相关的长期疾病患者如何回忆和解释英国初级保健中的体重对话。一位经验丰富的定性研究人员采访了 41 名年龄<42 岁、患有与超重相关的长期疾病的患者。研究人员寻求最大变异样本，并对转录的采访进行了主题分析。我们发现，患有与体重相关的长期疾病的患者对 GP 在支持体重管理方面的作用有不同的经历和期望。如果 GP 没有在长期疾病的背景下提出体重管理的问题，患者就会认为他们的超重没有被视为“可治疗的”，即不适合作为咨询的话题，而是个人或“生活方式”的问题。这些解释方式有多种，它们体现在两个主题中：将体重视为“可治疗的”；以及初级保健中的体重治疗。研究结果强调了在初级保健中增加对与体重相关的长期疾病的关注的必要性。如果 GP 以敏感、非评判的方式，并基于有效的证据进行干预，这种干预将受到欢迎。
