Weight management in general practice: what do patients want?

Daisy Tan, Nicholas A Zwar, Sarah M Dennis and Sanjyot Vagholkar
Med J Aust 2006; 185 (2): 73-75. || doi: 10.5694/j.1326-5377.2006.tb00474.x
Published online: 17 July 2006


Objective: To explore patients’ views of the role of general practitioners in weight management.

Design: Waiting-room questionnaire survey, including measurement of height, weight and waist circumference, May–August 2005.

Participants and setting: 227 patients from five general practices located in metropolitan and rural New South Wales.

Main outcome measures: Patients’ views on: the role of GPs in weight management; the usefulness of weight-loss strategies; and the likelihood of following the GP’s advice about weight loss.

Results: Most patients (78%) felt that GPs had a role in weight management, but only 46% thought that GPs would be able to spend enough time to provide effective weight loss advice. Over 80% of patients perceived advice on healthy eating and physical activity to be useful or very useful, and were likely to follow weight-loss recommendations; 78% were in favour of regular review. Patients indicated they would be less likely to see a dietitian or to attend information sessions, and unlikely to take weight-loss medication. Views of overweight and obese patients were generally similar to those of normal weight patients, but there were significant differences in perceptions of the usefulness of information on weight and weight-related medical conditions, as well as willingness to change lifestyle, possibly reflecting resistance to change among obese or overweight patients.

Conclusion: These findings have implications for the design of primary care interventions for managing obesity.

Levels of overweight and obesity in Australia have risen to epidemic proportions over the past two decades.1,2 As general practitioners are consulted by over 80% of the Australian population during the course of a year,3 they can play an important role in weight management programs.4,5

Although there has been research on GPs’ attitudes to managing overweight and obesity in their patients,6-9 little is known about what weight management advice patients actually want from their GPs,10 and no research on this aspect has been conducted in Australia.

The exploratory study reported here aimed to investigate patient views of the role of GPs in weight management.

Patients’ v GPs’ perceptions of the need for weight loss

Of the 227 patients, 71 (31%) felt they needed to lose weight and their GP had advised them to do so. However, another 75 patients (33%) who felt they needed to lose weight had not been advised by their GP to do so. We analysed the results of patient reports of GPs’ weight-loss advice according to measured BMI (Box 1). Five of 63 patients in the normal weight range reported that they had been advised by their GP to lose weight. Of 67 patients in the overweight category, 14 had been advised by their GP to lose weight, but 53 had not; and of 81 patients in the obese category, 53 had received GP advice to lose weight, but 28 had not.


Most of the patients surveyed believed that GPs have a role in weight management and the necessary knowledge and skills, but only 46% felt that GPs had enough time to provide effective weight loss advice. Surveys of GPs have shown that they hold similar sentiments regarding lack of time in managing weight problems in their patients.6,11,12

Patients expressed positive views about receiving lifestyle advice, such as dietary and physical activity guides from their GP. These options were favoured over medications and dietitian referral. There is evidence that nutritional counselling can produce improvement in weight.13 The results are encouraging for the effectiveness of strategies like the SNAP (smoking, nutrition, alcohol, and physical activity) framework14 and the Lifescripts resources.5

A survey of Australian GPs’ attitudes and practices regarding obesity management found that GPs viewed long-term follow-up as less likely to be important than the provision of advice about diet and physical activity.6 In contrast, in our study, patients felt regular review was a useful component of weight-loss management. Obesity is a chronic condition and long-term support from health professionals is recommended in managing this problem.2

It is interesting that, of the patients falling into the obese category, over a third said they had not been advised by their GPs to lose weight. The fact that these data rely on patient recall weakens their reliability, but they may indicate that GPs should be more proactive in instituting preventive health measures.

Patients were ambivalent about the usefulness of medications for weight loss, and half of them stated they would be unlikely to take medication to lose weight. Studies of GPs have also shown reluctance to prescribe medications for weight loss to obese patients,7,15 and that only a minority of GPs thought medication for weight loss was useful.6

There were significant differences between normal weight and overweight and obese patients in their perception of the usefulness of information on weight and weight-related medical conditions, as well as their willingness to change their lifestyle. This may reflect greater resistance to a behaviour change among those who are overweight or obese, consistent with the findings of a study from the United States.16 Further research to identify reasons for resistance to behaviour change in this group is needed.

A limitation of the study is that it involved only a small number of practices and may not reflect the views of all patients. The study also had limited power to detect small differences between normal-weight patients and overweight or obese patients. The assumption was that for any outcome of interest reported by the normal weight group the study had 80% power to only detect a difference greater than 21%, with the attendant risk of type 2 errors. In our study population, overweight and obesity levels were higher than estimated population levels17 and levels in other general practice surveys.18

In summary, most of the patients surveyed felt that GPs have a role to play in weight management and would favour advice on lifestyle changes for weight loss over other interventions. They felt regular review would be useful, and they would be willing to attend for follow-up care. Better understanding of what patients want from their GPs will help contribute to improved management and care for patients.

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