Beginning the journey
Read how these healthcare professionals describe their barriers for addressing obesity. We will hear them again at the end of the module to see what they have done to progress their practice.
The hospital doctor
Peter is a speciality trainee working in acute medicine and cardiology. He estimates that obesity has contributed to the presentation of at least 10% of the patients in his acute medical unit, yet has never seen his consultant or team raise the issue with his patients [role modelling]. He explains:
“I think it is partly the belief that raising the issue is unlikely to have much effect on our patients' behaviour [despondency] and frankly we wouldn't be saying anything other than ‘eat less, exercise more' which they probably know already [role adequacy]. When people are admitted we tend to deal with the acute presenting problem and leave health promotion to our primary care colleagues, though our smoking cessation services are pretty well organised now [role legitimacy]. I also think if someone is unwell enough to have been admitted, is now the time to be talking about their weight? [fear of offence]. Our team is pretty stretched as it is and I would be hesitant adding in-depth obesity counselling to our list of jobs [time pressures].”
The general practitioner
Dr Barker has seen a dramatic increase in the number of obese patients on her practice list since she completed her training and is concerned about the future impact on health services, but is unsure of how best this should be addressed.
“Obesity is obviously an emergent health need, but it simply wasn't an issue when I did my training. Although I am familiar with the NICE guidelines and I am reasonably confident in prescribing or referring to specialist services, I am less confident [role adequacy] in my ability to give behavioural change advice. If I am honest, I tend to skirt around dietary issues and I feel much more confident suggesting patients exercise more, though I am sure very few actually take my advice [despondency]. I have probably begun to normalise obesity to a certain extent. I make a point of raising the issue if patients have certain presenting complaints, such as knee pain, high blood pressure, impaired glucose tolerance, even incontinence, but I have never raised the issue unless there has been a clinical reason to do so, though I can see the rationale for this. I guess I am afraid of offending [fear of offence] or even harming people, particularly teenagers.”
The practise nurse
Jenny is an experienced practice nurse and already does a lot of counselling around dietary change as part of her diabetic clinic, but is less confident in extending this beyond that clinic. She explains:
“I have a very good relationship with most of my regular diabetic patients and we always have a conversation about diet during their reviews, though I'm not sure how much my patients listen [despondency]; however I also see a lot of obese parents and even children during other clinics, such as immunisation or smear testing but I wouldn't feel very comfortable raising the issue if there wasn't an obvious reason for doing so [fear of offence] and I have enough to get through in these clinics as it is [time pressures]. The GPs on my team sometimes refer patients to me specifically for weight loss advice - for some reason they think I have more time than them! - but I don't feel particularly well supported in this as I have never had any training in obesity counselling beyond the advice I give to my diabetic patients [role adequacy].”
