Obese Patients Get Patchy Weight-loss Support From Their Local Health Surgery

Sheffield-based researchers surveyed just under 400 nurses in the north of England in mid 2006, including district nurses, practice nurses and health visitors.

Their aim was to ask the nurses about their clinical practice, views and support for patients with obesity.

The researchers discovered that 89 per cent of nurses recognise the need for more effective primary care services to tackle obesity and see obesity advice and support as part of their role.

However, one in five nurses also admitted that they felt awkward or embarrassed about talking to patients about obesity and only a fifth felt they were effective when it came to helping patients to lose weight.

Half said that they found providing care and support for obese patients particularly rewarding, but some also expressed negative attitudes and beliefs.

It's estimated that one in five adults in the survey area -- which covered four primary care trusts in the north of England - are obese, reflecting national UK trends.

Many of the nurses in the current survey also had weight problems - 14 per cent were obese and 29 per cent were overweight.

"Primary care nurses have an important role when it comes to helping patients to tackle obesity, which can lead to diseases like coronary heart disease and diabetes" says lead researcher Dr Ian Brown from Sheffield Hallam University.

"But they clearly need further training and organisational support to provide the help that obese people need to lose weight, in line with new UK health guidelines.

"Any training programmes should also address nurses' beliefs and attitudes. While outright negatives stereotypes were rare, a number of nurses displayed potentially negative beliefs and attitudes relating to obesity and obese people. However, they were much less likely to do this if they were obese themselves"

Key findings of the study included:

Clinical practice

• 36 per cent of nurses (mainly practice nurses) carried out weight assessments in a typical week but another 36 said they'd never done one in their current post.
• 55 per cent had provided a patient with detailed advice about weight reducing diets and 30 per cent had done so in the last week, with similar percentages reported for exercise advice.
• 197 patients had been referred in the last four weeks -- including 39 per cent to local exercise activities which receive health funding, 27 per cent to a dietician and five per cent to psychological support.

Beliefs

• 88 per cent said the health risks of obesity were not being overstated, but five per cent felt they were.
• 59 per cent said that obesity was the root cause of most of the problems faced by overweight patients.
• 57 per cent felt family history was an important factor in obesity and 28 per cent said hormones were a factor in middle-aged obesity.
• 69 per cent felt obesity was down to personal choices about food and exercise.

Attitudes to obese patients

• 54 per cent of nurses felt empathy for obese patients, but four per cent felt disgust.
• 45 per cent didn't feel that obese patients had the motivation to change.
• 47 per cent found helping obese patients very rewarding.
• Eight per cent said obese patients were more lazy than non-obese patients.

Obesity management

• 59 per cent felt it was sufficient to give patients advice about weight management, but three per cent said that it wasn't part of their role.
• 22 per cent felt ineffective when it came to helping patients lose weight, 19 per cent felt awkward about raising the issue and 18 per cent felt embarrassed.
• 89 per cent said obesity was an important service development area.

Organisational support

• Only 17 per cent were aware of a specific clinical protocol at their practice for tackling obesity and only 11 per cent were aware of a lead clinician responsible for obesity management.
• 14 per cent said their practice had a well-developed programme for managing obese patients, but 37 per cent said it didn't and 49 per cent were unable to answer the question one way or another.

Study details

• 564 nurses across four Primary Care Trusts were surveyed and 398 responded.
• 96 per cent of the nurses who filled in the questionnaires were female and their average age was 46.
• The average body mass index of the respondents, calculated using their height and weight, was 25.5. 43 per cent were obese or overweight. 56 were normal weight and one per cent were underweight.
• District nurses made up 44 per cent of the sample, practice nurses 25 per cent and health visitors 22 per cent. The remainder were nursing assistants.

"Obesity is on the rise and it concerns us that front-line staff like primary care nurses are not receiving the training and support they need to help patients tackle the problem" concludes Dr Brown.

"The Government's advisory body, the National Institute for Health and Clinical Excellence, issued guidelines in December 2006 on how obesity should be managed by UK healthcare professionals, including local family doctors' surgeries.

"As a result, a number of new policy and service developments are underway, led by the Department of Health.

"However, our findings indicate that considerable development and training will be needed if effective and sensitive programmes are to be put in place."

 Reference: "Management of obesity in primary care: nurses' practices, beliefs and attitudes." Brown et al. Journal of Advanced Nursing. 59.4, pages 329-341.