PhD student Claire Pearce, an occupational therapist and senior project officer at ACT Health, is investigating how overweight and obesity prevention could be better incorporated into health services beyond primary care. She is using ACT Health as a case study.
She has found that guidelines developed for application in health services applied a simple, linear approach to obesity prevention: assess, provide advice about nutrition and physical activity, and refer on for support.
Barriers to action
But her interviews with a group of senior policy, population health and clinical executive revealed a number of barriers to action when clinicians encounter obese patients. A key factor is a sense of nihilism – that obesity prevention is ineffective or too late by the time people present to health services, Ms Pearce said.
“They think their efforts won’t make a difference anyway – that all they can do is treat people when they are sick and that the main challenge of care is ‘managing’ morbidly obese patients,” she said.
Interviewees also raised that obesity occurs as a result of individual choice, driven either by lack of will power or external factors. Some saw clinicians’ roles as imparting information to the individual and then leaving it up to them to make ‘better’ choices, while others believed it was necessary to help steer people toward better food choices through population-based initiatives such as limiting the marketing of junk food or taxing unhealthy foods.
“What really stood out from the interviews was the idea that whatever the drivers of choice, internal or external, obesity is ultimately a matter of individual failure and therefore health care can only be expected to have a limited impact,” Ms Pearce said. “The message was: it’s really down to the individual.”
Obesity and the model of care
The interviewees said prevention was difficult to fit within the existing medical model of care, which predominantly groups people by disease rather than functional issues.
They also questioned whether obesity is a disease. Some felt calling obesity a disease implied that an individual needed to be ‘cured’, even in the absence of poor health. Others said that if obesity was not classified as a disease it did not fit it into a disease-focused medical model of care.
“The medical model is also very strongly linked to financial incentives as a driver of activity, which was raised as a barrier to prevention within the current funding system,” Ms Pearce said.
“There is a sense they should be doing obesity prevention, but you can’t just tell people to change their practice if they don’t know whether what they’re doing is worthwhile.”
Her research has identified a gap in evidence around the role of community health services in obesity prevention.
She will take a systems approach involving research co-design with clinical managers to try to find ways of intervening to encourage clinicians to change practice and weave prevention into the health model.