Large men and New Zealand primary care: the views of practitioners and patients regarding obesity and its management

Abstract

Background New Zealand is ranked third in terms of obesity prevalence globally, with male obesity rates equalling those of females. There have been calls for primary care to take a more proactive approach to the diagnosis and management of obesity, but little is known about weight management practices within New Zealand general practice. Less is known regarding the weight management experiences of large men. This thesis aims to assess the beliefs, attitudes, knowledge and practices of general practitioners and practice nurses regarding obesity and specifically male obesity and explore the impact of these factors on large men. In addition, it seeks to understand the lived experiences of large Kiwi men. Methods This study utilised a mixed methods approach. The quantitative phase employed a random cross-sectional design and involved the development, piloting and administration of an extensive survey. The results were analysed using a combination of descriptive and inferential statistics. The qualitative phase used a thematic analytic approach and purposive sampling to recruit participants. An interview schedule was developed, piloted and used to guide the semi-structured interviews. Text data was analysed using general inductive principles. Results In total 1,344 surveys were returned by health professionals. Of these 735 were from practice nurses, creating a significant database of practice nurse information. Fourteen interviews with large men were completed and analysed thematically. The majority of health professionals considered weight management part of their role and obesity was deemed a chronic disease, underpinned by complexity. Individuals were viewed as responsible for their weight but needing weight loss support. Body mass index was the diagnostic measurement most frequently used and the majority were confident in their ability to provide weight management counselling, but time was a significant barrier. Both health professional groups considered male weight management would be enhanced by improved access to gender specific community-based options. The men felt weight was a sensitive topic but one that needed discussing using appropriate terms. Getting weighed was common but waist circumference measurement less so. Men expressed a desire for tailored weight loss advice and support, compared to the generic advice received. Their feelings on the need for primary care professionals to be role models were mixed. Overall life as a large man was challenging. Although these men experienced discrimination during interactions with general practice, they did not feel it was the main source of stigma in their lives, with discriminatory experiences more common from family, friends and work colleagues. Conclusion Considering the findings from the surveys and interviews together this thesis is able to provide guidance to primary care. The combined findings have clarified the role of contemporary primary care in regard to male weight management as being one of awareness raising, diagnosis and support for onward referral where appropriate. The synthesis of the findings revealed a shared model of obesity causation and responsibility between health professionals and large men, not seen in other studies. Opportunities exist for primary care to enhance its responsiveness to men seeking to lose weight, thereby making it a more suitable environment for large men seeking to lose weight in the future.