Prerequisites for primary care in obesity counselling and management : a quantitative, exploratory survey of general practitioners in the federal Republic of Germany
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Abstract
Background
Obesity, overweight and their associated diseases pose serious challenges to the health system. General practitioners are in an especially favourable position to contribute to obesity prevention, make timely diagnoses, and initiate treatment in their patients. Beyond individual findings, the German-speaking world has a lack of studies giving a reliable reflection of the status quo for obesity management in primary care towards establishing common attitudes and behaviour patterns in treating this patient cohort. The aim of the present study was to determine the opinions, attitudes, experiences, and desires for improvement amongst GPs regarding obesity care. The aim of this study is to serve as a basis for developing an approach towards optimisation.
Methods
All 13,912 GPs in active practice in Baden-Württemberg, Hesse, Rhineland-Palatinate, and Saarland between January and April 2024 were invited to take part in an online survey. A total of 4,038 fully completed questionnaires were included in the analysis; this corresponds to a response rate of 29%. Apart from descriptive analysis, Student’s t-test for independent samples was performed to determine significant differences between two groups.
Results
The results have shown that most GPs see obesity as a major challenge that is clearly on the increase. Many of the GPs surveyed saw it as their responsibility to care for and provide therapeutic support for their overweight and obese patients. GPs especially prioritised assessing individual life situations surrounding their patients in the causes and consequences of overweight during weight counselling. Every second respondent provided dietary counselling, but fewer gave exercise counselling. Only some respondents used the opportunity to recommend specific health services to patients or refer their patients to these services. Respondents addressed dietary changes followed by psychosocial support and physical exercise issues. GPs were often unsatisfied with obesity management outcomes. This was worsened by general lack of time, resources, and connections to interprofessional support networks. Two groups in the sample stood out as drawing more optimistic conclusions after reflecting on their own counselling activities and therapeutic interventions. One group comprised GPs with specific additional qualifications, especially in diet and sports medicine. The other group consisted of GPs who regularly used digital health apps (DHAs) in their therapeutic approach; physicians in this group were markedly more satisfied with the results of disease management in their patients. Many respondents welcomed the introduction of the German DMP Adipositas obesity management programme and showed great interest in taking part in it. Many GPs expressed a desire for an easier overview of available local and regional health services.
Conclusions
Even with the favourable conditions of primary care, the interview results indicate that the potential in primary care is currently not being fully exploited in overweight and obesity management. It would seem to make sense to raise awareness amongst GPs as to the circumstances of obesity while encouraging more motivational and behavioural consultation with patients. An obesity diagnosis should include actual recommendations on diet and exercise. Focussed diet and exercise counselling would also be welcome in primary care. GPs should also be encouraged to take on a role as mediators by referring patients to a broader healthcare network as necessary. Increased effort should be made towards developing structured, GP-compliant care programmes for obesity management towards implementing evidence-based treatment concepts adaptable to patient needs.