Background: While primary care is positioned to be best suited to deliver weight management healthcare, the highly individualised patient experience of obesity, coupled with the difficult and intricate nature of communicating obesity healthcare messages in appropriate and non-stigmatising ways, makes the role of a GP increasingly complicated even before a patient even decides to engage with any obesity healthcare options. Difficulties in discussing the topic of weight in healthcare consultations include communication barriers, clinical relevance of weight, sociocultural norms and avoiding any potentially stigmatising or discriminating experiences. However, a key limitation of previous literature is the reliance on participant recall or participant perspective of weight discussions and there is little understanding of how weight is 'actually' discussed in GP-patient consultations. In an Australian first, this study aimed to explore discussion strategies used in real-world video recorded GP-patient consultations when discussing obesity.
Method: Secondary data analysis of Australia’s first, and only, Digital Library video recorded consultations was used. Fourty-seven consultations and patient post-consultation satisfaction surveys were analysed using descriptive content analysis with seventeen consultations discussing weight in some manner. A multi-disciplinary research team, including obesity lived experience experts, obesity lived experience researchers, health professionals and practicing GPs, identified three overarching themes for how weight was discussed.
Results: 15/17 discussions about health in relation to weight were GP initiated and 2/17 were patients initiated. Fourteen used a structured approach (all GP initiated), while three used an opportunistic approach (one GP and two patients initiated). GPs raised the concept of weight in a patient-autonomous way, asking for consent to discuss weight as part of their routine care, or giving space for the patient to decline discussion. Weight was always positioned as a factor in relation to another presenting health concern of the patient and was discussed in positive, encouraging ways that were relative to each individual patient’s health context.
Conclusions: This study of naturally occurring GP-patient consultations highlighted the intricacies of ways the delicate topic of weight was approached in consultations. While there was no overt discourse or behaviour from patients to indicate obesity stigma was present in these consultations, potentially stigma could have been internalised or perceived by patients. With the majority of weight discussions initiated by GPs in structured ways in these consultations, future research could look to develop specific evidence based non-stigmatising ‘weight’ discussion prompters for GPs to refer to in their practice for flexible consistency with the range of patients seen. This could help empower GPs with confidence to discuss weight in consultations and ensure potential covert stigma is minimised.