Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand.
Strategy, Investment and Transformation, Waikato District Health Board, Hamilton, New Zealand.
Obes Rev. 2022 Oct;23(10):e13495. doi: 10.1111/obr.13495. Epub 2022 Jul 14.
Obesity is a complex international health concern affecting individual quality of life and contributing to an unsustainable strain on national health systems. General practice is positioned as best suited to deliver weight management health care, yet, obesity rates remain high suggesting barriers are experienced within this space. The aim of this review is to synthesize general practitioner and client perspectives of weight management to identify barriers experienced in New Zealand general practice. Six databases were searched resulting in eight articles being included in this review. This interpretive synthesis was guided by principles of meta-ethnography and grounded theory. Four overarching themes were identified from client and general practitioner perspectives: stigma, communication, inadequate health care (system limitations for general practitioners and lack of tailored advice for clients), and sociocultural influences. These four barriers were found to be interdependent, influencing each other outside the general practice context, highlighting the intersectionality of weight management health-care barriers and further complicating effective weight management within general practice. Clients reported wanting tailored, non-stigmatized, effective weight management health care, yet, general practitioners reported being ill-equipped to provide this due to barriers both within and outside the limits of their practice. General practice requires more systemic support to deliver effective weight management including public health campaigns and indigenous health information to reduce health inequities. An appraisal of general practice being "best suited" to deliver effective weight management health care that is culturally appropriate is urgently required to improve obesity related health outcomes in New Zealand.
肥胖是一个复杂的国际健康问题，影响个人的生活质量，并对国家卫生系统造成不可持续的压力。全科医学最适合提供体重管理保健服务，但肥胖率仍然居高不下，这表明在这一领域存在障碍。本综述的目的是综合全科医生和患者对体重管理的观点，以确定新西兰全科实践中存在的障碍。共搜索了六个数据库，最终有八篇文章纳入本综述。这项解释性综合研究遵循元民族学和扎根理论的原则。从患者和全科医生的角度确定了四个总体主题：耻辱感、沟通、医疗保健不足（全科医生的系统限制以及缺乏针对患者的定制建议）以及社会文化影响。这四个障碍被发现是相互依存的，在全科医学之外相互影响，突出了体重管理保健障碍的交叉性，使全科医学中的有效体重管理更加复杂。患者希望获得定制的、非污名化的、有效的体重管理保健，但全科医生报告说，由于实践内外的障碍，他们无法提供这种服务。全科医学需要更多的系统支持来提供有效的体重管理，包括公共卫生运动和土著健康信息，以减少健康不平等。迫切需要评估全科医学是否“最适合”提供文化上适当的有效体重管理保健，以改善新西兰与肥胖相关的健康结果。
