obesity in 3d

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Obesity in 3D:

a qualitative comparison of general

practitioners, dietitians and

nurses’ views about obesity

Filipa Teixeira ([email protected])

José Luis Pais-Ribeiro (FPCEUP) & Ângela Maia (UMinho)

28th Conference of the European Health Psychology Society

August 27th, 2014

Innsbruck, Austria

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• Obesity as one of the 21st century epidemic (WHO, 2013):

• In Portugal, 46,7% of men and 38,1% of women are overweight

about 20% are obese (Carmo et al., 2007; Sardinha et al., 2012)

• Development of primary, secondary and tertiary interventions measures: (Ogden, 2011)

• healthcare professionals role

• primary health care setting

Little effectiveness and negative outcomes (Kristeller & Hoerr, 1997; Ogden & Flanagan, 2008)

Why? – Literature Review

Filipa Teixeira 28th Conference of the European Health Psychology Society, Innsbruck August 2014

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Healthcare professionals one of possible responsibles for failures

General Practitioners:

• Uncoordinated and inconsistent approach

• Negative attitudes

• Unsufficient knowledge

Dietitians and nurses:

• few data available - controversial and

not conclusive

• need more research

(Epstein & Ogden, 2005; Fogleman et al., 2002; Ogden, 2011; Teixeira, Pais-Ribeiro, & Maia, 2012)

Primary quantitative

research

Lack of comparative

research

What about in Portugal????

Why? – Literature Review


Filipa Teixeira

palavra original é: primaziaprimacy fica muito aportuguesado e nem sei se se usa muito em inglês; dominance remete numa primeira leitura para controlo de algo; talvez superiority??' preference???

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3. how they perceive their role in obesity treatment

2. how they explain and perceive their practices in terms of treatment effectiveness and obtained outcomes

What? – Research Aims

1. their perception about obesity and obese patients

Understand…

General Practitioners Dietitians Nurses


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GPs Dietitians Nurses Total

SexMale 7 2 3 12

Female 9 14 9 32

Total 16 16 12 44

Mean Age (SD) 51,75 (9,73) 33,06 (8,44) 38,58 (9,32) 41,13 (9,60)

Minimum 32 24 26 -

Maximum 64 57 52 -

Average work experience (SD)

24,25 (10,57) 9,06 (7,55) 15,83 (9,28) 16,38 (7,61)

Minimum 5 2 4 -

Maximum 34 30 29 -

Who? - Method


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Where? - Method

•Primary healthcare centers in the

North of Portugal (Braga, Porto and

Aveiro)

•Dietitians from private clinics,

pharmacies, gyms, hospitals (public

and private)


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• Instrument:

• Semi-structured interviews

• Audio recorded with participant consent

• Transcribed verbatim

• Analysis according to Thematic Analysis procedures (Boyatiz, 1998;

Braun & Clarke, 2006)

How? - Method


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• Concerns about obesity as a public health disease

• Characteristics of obese people vs. Treatment demands

Results

Similarities

Differences

• Practices

•Perception about the change process

•Perceived role


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Results - Similarities


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“…they’re always coming with excuses. They have on for everything that is going wrong. Sometimes they don’t have the strenght and willingness we first thought they would have.” (GP12)

“They say they’ll change, but they don’t!” (GP3)


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“… they bring too many high expectations! They want to lose 15kg in a blink of na eye!” (Nur 8)

“…some still ask for a pill, the miraculous pill that’s going to help them!” (GP 5)

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“… they bring too many high expectations! They want to lose 15kg in a blink of na eye!” (Nur 8)

“…some still ask for a pill, the miraculous pill that’s going to help them!” (GP 5)

“You cannot do it without motivation, without the strenght and willingness to change! You just can’t!” (GP 12)

“Without motivation we can’t get anywhere!” (Diet 1)

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Results – Differences – General Practitioners

“Lack of time”DisengagementEthical conflict

Powerlessness

Frustration

Characteristics of obese

Vs.

Treatment demands

Cultural factors

Low expectations of sucess

Treatment as difficult to perform

Barriers to intervention

Obese people attitudes towards obesity

GPs’ attitudesDenial

Lack of recognition

Non-compliance

Failures

Passive Role

Professional duty

Obese inability to comply

vs


Filipa Teixeira

palavra original é: impotência - mas se traduzido à letra para o inglês - impotence - surge mais associado ao problema da disfunção sexual e acho que não é bem isso que queremos :) acho que powerlessness traduz bem a ideia de sensação de falta de controlo dos médicos sobre o tratamento da obesidade

Filipa Teixeira

palavra original é: resignação no sentido de passividade, de "baixarem os braços". A palavra "defeatism" traduz bem a ideia de desistência da luta (e acho que permite fazer bem o contraste com os dados dos nutricionistas e enfermeiros cuja palavra é persistência - persistency). No entanto, em inglês parece-me repetitivo ter powerlessness e defeatism separados... e se juntássemos num só balão estas duas palavras e fosse este balão a categoria central do modelo???

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Results – Differences – Dietitians and Nurses – Change Process

Failure Success

Ob Unmotivated Ob Motivated

• “the easy ones”• “accept everything”

• “do not comply”• “refuse to change”• “lack of time”

Disengage

Indifference

Compliance

Obese and professional satisfaction

Resistant to comply

• “slower change”• “the difficult ones”• “more investment”

Challenge

PersistenceBelief in success

“RING”Struggle

NEGOTIATION

FRUSTRATION


Filipa Teixeira

palavra inicial: abandono, no sentido de darem alta ao doente, de (perante a desmotivação e falta de interesse do obeso) não "quererem saber", abandonarem o caso/ desistirem. Não sei se a palavra traduzirá bem esse sentido.

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Results – Differences – Dietitians and Nurses – Change Process

Failure Success

Ob Unmotivated Ob Motivated



Disengage

Indifference

Compliance


Resistant to comply

• “slower change”• “the difficult ones”• “more investment”

Challenge

PersistenceBelief in success

“RING”Struggle

NEGOTIATION

FRUSTRATION


Disengage

Indifference


Compliance



Filipa Teixeira

palavra inicial: abandono, no sentido de darem alta ao doente, de (perante a desmotivação e falta de interesse do obeso) não "quererem saber", abandonarem o caso/ desistirem. Não sei se a palavra traduzirá bem esse sentido.

“RING”Struggle

NEGOTIATION

Results – Differences - Dietitians

Public Setting Private Setting

Persistence

• Unmotivated obese• Failures• Frustration• Barriers

Less persistence

• Motivated obese• Success• Satisfation

More persistence

Do not persist

Challenge


Belief in success

Filipa Teixeira

less or minor???

Filipa Teixeira

more or major

“RING”Struggle

NEGOTIATION

Results – Differences - Dietitians

Public Setting Private Setting

Persistence

• Unmotivated obese• Failures• Frustration• Barriers

Less persistence

• Motivated obese• Success• Satisfation

More persistence

Do not persist

Challenge


Belief in successBelief in success

“RING”Struggle

NEGOTIATION

Filipa Teixeira

less or minor???

Filipa Teixeira

more or major

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Discussion

GPs

Dietitians NursesActive Role - Persistence

Passive Role – Disengage

Negative beliefs and attitudes

“blaming the victim”

(Campbell & Crawford, 2000; Epstein & Ogden, 2005; Fogleman et al., 2002; Foster et al., 2003 ; Hoppé & Ogden, 1997)

•Proper knowledge

•Belief in their advice giving skills control

• Patient centered care

(Sonntag et al., 2012)•Insufficient knowledge

•Little perception of control

• failures

• no of obese

• Biomedical Model

More curative than preventive

(Bocquier et al. 2005; Foster et al., 2003; Visser, 2008)

(Campbell & Crawford, 2000; Hoppé & Ogden, 1997)


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Discussion

GPs

Dietitians NursesActive Role - Persistence

Passive Role – Disengage

•Proper knowledge

•Belief in their advice giving skills control

• Patient centered care

(Sonntag et al., 2012)•Insufficient knowledge

•Little perception of control

• failures

• no of obese

• Biomedical Model

More curative than preventive

(Bocquier et al. 2005; Foster et al., 2003; Visser, 2008)

(Campbell & Crawford, 2000; Hoppé & Ogden, 1997)


“GAP”

Lack of communication and

colaboration

Negative beliefs and attitudes

“blaming the victim”

(Campbell & Crawford, 2000; Epstein & Ogden, 2005; Fogleman et al., 2002; Foster et al., 2003 ; Hoppé & Ogden, 1997)

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Implications for practice

• Missing intervention opportunities in primary health care

• Make professionals aware of the relationship between beliefs practices, relationship, compliance and outcomes

• Motivational strategies training(ex.: nutrition coaching)

Multidisciplinary teams

Colaboration with psychologists

Communication training


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Limitations and further research

• Limitations:

• Convinience sampling

• Reduced number of participants

• Specific area of Portugal

• Differences in age and years of experience among GPs and dietitians/nurses

• Further research:

• obese people perception about their disease and their healthcare professional;

• Relationship between age, years of experience, own weight and body image practices and compliance outcomes


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Thank you for your

attention!

Filipa Valente TeixeiraUniversity of Porto

[email protected]


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References

• Bocquier, A., Verger, P., Basdevant, A., Andreotti, G., Baretge, J., Villani, P., & Paraponaris, A. (2005).

Overweight and obesity: knowledge, attitudes, and practices of general practitioners in france. Obes

Res, 13(4), 787–795. doi:10.1038/oby.2005.89.

• Boyatiz, R. (1998). Transforming qualitative information: Thematic analysis and code development.

Sage Publication: Thounsand Oaks.

• Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in

Psychology, 3, 77-101.

• Campbell, K. & Crawford, D. (2000). Management of obesity: attitudes and practices of Australian

dieticians. International Journal of Obesity, 24, 701-710.

• Carmo, I., Santos, O., Camolas, J., Vieira, J., Carreira, M., Medina, L., … Galvão-Teles, A. (2007).

Overweight and obesity in Portugal: national prevalence in 2003-2005. Obesity Reviews, 9, 11-19.

• Epstein. L., & Ogden, J. (2005). A qualitative study of GP’ views of treating obesity. British Journal of

General Practice, 55, 750-54.


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• Fogelman, Y., Vinker, S., Lachter, J., Biderman, A., Itzhak, B., & Kitai, E. (2002). Managing obesity: a

survey of attitudes and practices among Israeli primary care physicians. International Journal of

Obesity, 26, 1393-97.

• Foster, G. D., Wadden, T. a, Makris, A. P., Davidson, D., Sanderson, R. S., Allison, D. B., & Kessler, A.

(2003). Primary care physicians’ attitudes about obesity and its treatment. Obesity Research, 11(10),

1168–77. doi:10.1038/oby.2003.161.

• Hoppé, R., & Ogden, J. (1997). Practice nurses’ beliefs about obesity and weight related

interventions in primary care. International Journal of Obesity and Related Metabolic Disorders,

21(2), 141–6.

• Kristeller, J., & Hoerr, R. (1997). Physicians attitudes toward managing obesity: differences among six

specialty groups. Preventive Medicine, 26, 542-549.

• Ogden, J. (2011). The Psychology of eating: from healthy to disordered behaviour. Blackwell: US/ UK.

• Ogden, J., & Flanagan, Z. (2008). Beliefs about the causes and solutions to obesity: A comparison of

GPs and lay people. Patient Education and Couseling, 71, 72-78.

References


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• Sardinha, L. B., Santos, D. a, Silva, A. M., Coelho-e-Silva, M. J., Raimundo, A. M., Moreira, H., … Mota,

J. (2012). Prevalence of overweight, obesity, and abdominal obesity in a representative sample of

Portuguese adults. PloS One, 7(10), e47883. doi:10.1371/journal.pone.0047883.

• Sonntag, U., Brink, A., Renneberg, B., Braun, V., & Heintze, C. (2012). GPs’ attitudes, objectives and

barriers in counselling for obesity--a qualitative study. The European Journal of General Practice,

18(1), 9–14. doi:10.3109/13814788.2011.627424

• Teixeira, F. V., Pais-Ribeiro, J. L., & Maia, Â. (2012). Beliefs and practices of healthcare providers

regarding obesity: a systematic review. Revista Da Associação Médica Brasileira, 58(2), 254–62.

• World Health Organization (2013). What are overweight and obesity? Retrieved on September, 25 th,

2008 from http://www.who.int/mediacentre/factsheets/fs311/en/index.html

• Visser, F., Hiddink, G., Koelen, M., van Binsbergen, J., Tobi, H., & van Woerkum, C. (2008).

Longitudinal changes in GPs’ task perceptions, self-efficacy, barriers and practices of nutrition

education and treatment of overweight. Family Practice, 25 Suppl 1, i105–11.

doi:10.1093/fampra/cmn07.

References


http://www.who.int/mediacentre/factsheets/fs311/en/index.html

obesity in 3d

Science

obesity filipa teixeira

method filipa teixeira

private filipa teixeira

obesity treatment

aveiro dietitians

research epstein ogden

nurses views

development of primary