Barriers to obesity management: a pilot study of primary care clinicians

Treatment of Overweight and Obesity in Primary Care Practice: Current Evidence and Future Directions

Obesity is commonly encountered in primary care practice. Yet many patients who are overweight or obese are not identified, and those who are do not receive adequate treatment or referral. For many primary care providers, barriers to addressing weight control with patients include lack of time, limited training and resources, patient readiness to change, and inadequate insurance reimbursement. Studies that have evaluated weight control interventions in primary care vary tremendously in design and methodology. Most studies have focused on primary care provider training or practice-level interventions, or they have combined physician and nutrition counseling. Although results from these studies are encouraging, more randomized clinical trials are needed in this area. Future avenues for study include electronic health records, computer-tailored interventions, and translation of efficacious weight control interventions into primary care settings.

Do internists, pediatricians, and psychiatrists feel competent in obesity care?: using a needs assessment to drive curriculum design

BACKGROUND

Physicians must effectively evaluate and treat obesity. To design a needs-driven curriculum intended to improve patient outcomes, physicians were surveyed about their self-perceived knowledge and skills.

OBJECTIVE

The objective of this study was to determine the expressed needs of residents and faculty regarding obesity care training across three specialties.

DESIGN

The study used a survey given to faculty and residents in General Internal Medicine, Pediatrics, and Psychiatry.

METHODS

Survey questions were generated from comprehensive nutrition curriculum and clinical recommendations, administered online, and then organized around a validated behavioral health framework-the 5As (assess, advise, agree, assist, arrange). Analyses were conducted to evaluate differences in perceived knowledge and skills between specialties and across training levels.

RESULTS

From an overall response rate of 65% (65 residents and 250 faculty members), nearly 20% reported inadequate competency in every item with 48% of respondents reporting an inability to adequately counsel patients about common treatment options. Internists reported the lowest competency in arranging referrals and follow-up. Psychiatrists reported the lowest competency in assessment skills.

CONCLUSIONS

This survey demonstrated a critical need for training in specific areas of obesity care. The proposed curriculum targets these areas taking into consideration observed differences across specialties.

Barriers to obesity treatment

Obesity, one of the most prevalent health problems in the Western world, is a chronic and progressive condition. Therefore, as with other chronic diseases, patients with obesity require lifelong treatment. Long-term efficacy and effectiveness of obesity treatments is notoriously poor. This may in part be attributable to the substantial barriers that undermine long-term obesity management strategies. These can include lack of recognition of obesity as a chronic condition, low socioeconomic status, time constraints, intimate saboteurs, and a wide range of comorbidities including mental health, sleep, chronic pain, musculoskeletal, cardiovascular, respiratory, digestive and endocrine disorders. Furthermore, medications used to treat some of these disorders may further undermine weight-loss efforts. Lack of specific obesity training of health professionals, attitudes and beliefs as well as coverage and availability of obesity treatments can likewise pose important barriers. Health professionals need to take care to identify, acknowledge and address these barriers where possible to increase patient success as well as compliance and adherence with treatments. Failure to do so may further undermine the sense of failure, low self esteem and self efficacy already common among obese individuals. Addressing treatment barriers can save resources and increase the prospect of long-term success.

Clinical assessment and management of obesity in individuals with spinal cord injury: a review

BACKGROUND

Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging.

METHODS

Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed.

FINDINGS

Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising.

CONCLUSIONS

The best anthropometric tool to define obesity in the clinical setting remains unknown. SCI-specific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.