Role of the family doctor in the management of adults with obesity: a scoping review.

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obesity 74 Title: BMJ OpenRole of the family doctor in the management of adults with obesity : a scoping reviewElizabeth A SturgissNicholas ElmittEmily HaelserChris van WeelKirsty A Douglas [1]Canberra
obesity 516 scoping review examines the literature describing the role of the family doctor in managing adults with obesity . The methods were prospectively published and followed Joanna Briggs Institute methodology.SettingPrimary
obesity 718 methodology.SettingPrimary care. Adult patients.Included papersPeer-reviewed and grey literature with the keywords obesity , primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate
obesity 1216 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention
obesity 1609 extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role
obesity 2090 observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care
obesity 3222 with diseases such as diabetes, osteoarthritis, cardiovascular disease and depression.[1] As such, obesity is a condition that is commonly associated with a larger set of health issues encountered by an individual.
obesity 4005 patient’s preference for care.[4] Thus, the literature that focuses on the management of adults with obesity by the family doctor is important to understand.With the rising numbers of adults living with obesity
obesity 4107 obesity by the family doctor is important to understand.With the rising numbers of adults living with obesity and related chronic diseases, there is an increasing demand from health systems for primary care, and
obesity 4486 explore the effectiveness of primary care, as well as the involvement of different practitioners in obesity management. However, our initial explorations into this literature found a lack of clarity in this area.
obesity 4748 patterns, and gaps, in the literature based on the role of the family doctor in managing adults with obesity .The term used to describe a family doctor varies internationally, and includes general practitioner
obesity 5339 intervention and it is important for family doctors to understand what skills they offer in the setting of obesity management. The importance of understanding provider role is demonstrated in the methodology of critical
obesity 6956 current research base, and broader literature, for the role of the family doctor in managing adults with obesity .The objectives, inclusion criteria and methods of analysis for this review were specified in advance
obesity 7253 were:What supporting evidence (both primary and secondary) do we have for the role family doctors play in obesity management for adults in primary care?What is the role of the family doctor in managing obesity as a
obesity 7349 in obesity management for adults in primary care?What is the role of the family doctor in managing obesity as a primary risk as supported by the evidence base?What do primary care guidelines say about the role
obesity 8102 when they involved adults (18+ years) with a body mass index (BMI) of greater than 25 (overweight or obesity ), any involvement of a primary care doctor/physician, a primary care setting and inclusion of obesity
obesity 8204 obesity), any involvement of a primary care doctor/physician, a primary care setting and inclusion of obesity management (online supplementary file 1). Contrary to our outlined protocol, we excluded papers in languages
obesity 9073 accessible.10.1136/bmjopen-2017-019367.supp1Supplementary file 1This scoping review was purposefully restricted to obesity management of adults in primary care. As suggested in the Joanna Briggs Institute methodology, the scope
obesity 9313 feasibility while maintaining a broad and comprehensive approach. By restricting the scoping review to obesity , we were able to extract more detail about the family doctor’s role than if we had included articles
obesity 9699 care or physical activity advice unless they were specifically in relation to care of a patient with obesity . Due to the differences in the management of obesity in children and adolescents these population groups
obesity 9752 specifically in relation to care of a patient with obesity. Due to the differences in the management of obesity in children and adolescents these population groups were not included in this review.Two reviewers (EAS,
obesity 10339 pillars of primary care were identified. Whole person care was judged as included if the paper described obesity management provided in the context of other health needs. Person-centredness was considered as incorporated
obesity 11042 Reviews and Meta-Analyses (PRISMA) flow diagram for scoping review of the role of family doctors in obesity management.We iteratively developed the data extraction tool based on the information we found in a
obesity 11869 extraction in full.Our scoping review of interventions involving family doctors in the management of obesity drew on the Template for Intervention Description and Replication (TIDieR) guidelines for the description
obesity 13624 reviewed.What supporting evidence (both primary and secondary) do we have for role family doctors play in obesity management for adults in primary care?Of the 225 articles that were included in the review, 110 were
obesity 14227 randomised controlled trials (RCT) (table 1). A majority of interventions on the management of adults with obesity stem from the USA, and RCTs are a common study design.Table 1Number of different interventions identified
obesity 14418 interventions identified in scoping review that describe a role for the family doctor in primary care obesity management—by country where the intervention was undertaken, and study designCountry of interventionStudy
obesity 15019 intervention1 Spain1 Switzerland4 UK5 UK/Australia/Germany1 UK/Scotland1 USA44Total77Total77RCT, randomised controlled trial.Table 2Interventions in primary care in the management of adult obesity involving the general practitioner (over seven pages)AuthorMultiple[21]Multiple[23]Bolognesi et al[30]Bodenlos[31]Kerr
obesity 23347 total of 74 articles that were clinical overviews and opinion papers on the primary care management of obesity that included discussion of the role of the family doctor (table 3), and 25 papers that described current
obesity 23491 of the family doctor (table 3), and 25 papers that described current practice of family doctors in obesity management, usually through surveys or clinical audits (table 4). There were 16 international guidelines
obesity 23660 4). There were 16 international guidelines relevant to family doctors focused on the management of obesity (table 5).Table 3Clinical overviews and opinion articles on the role of the family doctor in the management
obesity 23785 3Clinical overviews and opinion articles on the role of the family doctor in the management of adult obesity in primary care (over seven pages)AuthorAnderson and Wadden[130]Rao[131]Simkin-Silverman et al[132]Logue
obesity 24129 the obese patient: suggestions for primary care practiceOffice-based strategies for the management of obesity Treatment of overweight and obesity in primary care practice: current evidence and future directionsObesity
obesity 24164 primary care practiceOffice-based strategies for the management of obesityTreatment of overweight and obesity in primary care practice: current evidence and future directionsObesity management in primary care:
obesity 24412 assessment and management in primary careHealth coaching integration into primary care for the treatment of obesity Modified 5 As: minimal intervention for obesity counseling in primary carePatient preparation for bariatric
obesity 24459 coaching integration into primary care for the treatment of obesityModified 5 As: minimal intervention for obesity counseling in primary carePatient preparation for bariatric surgeryLaparoscopic adjustable gastric bandingBariatric
obesity 24602 preparation for bariatric surgeryLaparoscopic adjustable gastric bandingBariatric surgery for morbid obesity : why, who, when, how, where, and then what?CountryUSAUSAUSAUSAUSAUSACanadaUSAAustraliaUSAYear1999201020082001200120132013201420092002Overview/opinionOverviewOverviewOverviewEditorialOverviewOpinionOverviewOverview
obesity 25676 al[146]Snow et al[147]Van Sickle[148]Virji and Murr[149]Wilbert et al[150]TitleBariatric surgery for morbid obesity Referral for a bariatric surgical consultation: it is time to set a standard of careEndocrine and nutritional
obesity 26195 bariatric surgery in Kaiser Permanente Southern CaliforniaPharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of PhysiciansManagement of
obesity 27531 al[161]TitleWeight loss strategies that really workHow useful are clinical guidelines for the management of obesity in general practice?Care pathways for the prevention and management of obesityManaging obesity like
obesity 27610 for the management of obesity in general practice?Care pathways for the prevention and management of obesity Managing obesity like any other chronic condition. Long-term therapy may reduce comorbidity as wellManagement
obesity 27626 management of obesity in general practice?Care pathways for the prevention and management of obesityManaging obesity like any other chronic condition. Long-term therapy may reduce comorbidity as wellManagement of obesity
obesity 27730 obesity like any other chronic condition. Long-term therapy may reduce comorbidity as wellManagement of obesity in adultsMotivating patients toward weight loss: practical strategies for addressing overweight and
obesity 27838 in adultsMotivating patients toward weight loss: practical strategies for addressing overweight and obesity Can primary care physician-driven community programs address the obesity epidemic among high-risk populations?The
obesity 27910 for addressing overweight and obesityCan primary care physician-driven community programs address the obesity epidemic among high-risk populations?The management of adult obesityObesity, legal duties, and the family
obesity 27979 community programs address the obesity epidemic among high-risk populations?The management of adult obesity Obesity, legal duties, and the family physicianApproaching the obese patients in primary health care
obesity 28136 physicianApproaching the obese patients in primary health care in the Czech RepublicAn evidence-based guide for obesity treatment in primary careCountryUSAUKUKUSAUSAUSAUSACanadaCanadaCzech RepublicUSAYear20102009200420002014200320132003200720072015Overview/opinionOverviewGuideline
obesity 29221 and Wyatt[168]Iacobucci[169]Kausman and Bruere[170]Kolasa[171]TitleA multidisciplinary approach to obesity management: the physician’s role and team care alternativesDevelopment process of an evidence-based
obesity 29362 role and team care alternativesDevelopment process of an evidence-based guideline for the treatment of obesity Strategies to facilitate weight loss in patients who are obeseObesity—recommendations for management
obesity 29558 for management in general practice and beyondFP’s patients are successful ‘losers’Dealing with obesity as a chronic diseaseOutpatient management of obesity: a primary care perspectivePay GPs to tackle obesity,
obesity 29611 patients are successful ‘losers’Dealing with obesity as a chronic diseaseOutpatient management of obesity : a primary care perspectivePay GPs to tackle obesity, doctors urge UK governmentIf not dieting, now
obesity 29664 obesity as a chronic diseaseOutpatient management of obesity: a primary care perspectivePay GPs to tackle obesity , doctors urge UK governmentIf not dieting, now what?Summary of clinical guidelines on the identification,
obesity 29822 what?Summary of clinical guidelines on the identification, evaluation, and treatment of overweight and obesity CountryUSAGermanyUSAAustraliaUSAUSAUSAUKAustraliaUSAYear1998200120102013201019982002201420061999Overview/opinionOverviewOverviewSingle
obesity 30826 et al[177]Nichols and Bazemore[178]Nonas[179]Orzano and Scott[180]Ossolinski et al[181]TitleTackling obesity : is primary care up to the challenge?General principles in the primary care of obesityPhysicians need
obesity 30913 al[181]TitleTackling obesity: is primary care up to the challenge?General principles in the primary care of obesity Physicians need practical tools to treat the complex problems of overweight and obesityWeight management
obesity 31000 primary care of obesityPhysicians need practical tools to treat the complex problems of overweight and obesity Weight management in primary care: how can it be made more effective?New perspectives on diagnosis and
obesity 31123 management in primary care: how can it be made more effective?New perspectives on diagnosis and treatment of obesity Winnable Battles: family physicians play an essential role in addressing tobacco use and obesitySupporting
obesity 31220 of obesity Winnable Battles: family physicians play an essential role in addressing tobacco use and obesity Supporting behavior change in overweight patients: a guide for the primary care physician Winnable Battles:
obesity 31406 physician Winnable Battles: family physicians play an essential role in addressing tobacco use and obesity for the primary care physicianWinnable Battles: family physicians play an essential role in addressing
obesity 31533 care physicianWinnable Battles: family physicians play an essential role in addressing tobacco use and obesity A model for chronic care of obesity through dietary treatmentDiagnosis and treatment of obesity in adults:
obesity 31568 physicians play an essential role in addressing tobacco use and obesityA model for chronic care of obesity through dietary treatmentDiagnosis and treatment of obesity in adults: an applied evidence-based reviewWeight
obesity 31628 and obesityA model for chronic care of obesity through dietary treatmentDiagnosis and treatment of obesity in adults: an applied evidence-based reviewWeight management practices and evidence for weight loss
obesity 32744 et al[185]Scherger[186]Schlair et al[187]Spira[188]Thompson et al[189]Tsai et al[190]TitleManaging obesity in adults in primary careNew and emerging weight management strategies for busy ambulatory settings:
obesity 33045 behavioral medicineObesity: a move from traditional to more patient-oriented managementWhittling away at obesity and overweight: small lifestyle changes can have the biggest impactPrimary care physicians: on the front
obesity 33184 changes can have the biggest impactPrimary care physicians: on the front line in the fight against obesity How to deliver high-quality obesity counseling in primary care using the 5As frameworkManaging obesity
obesity 33219 impactPrimary care physicians: on the front line in the fight against obesityHow to deliver high-quality obesity counseling in primary care using the 5As frameworkManaging obesity in general practiceTreatment of obesityObesityCountryCanadaUSAUSAUSAUSAUSAUKUSAUSAYear201220111995200519992012198320072010Overview/opinionOverviewOverviewOverviewOverviewOverviewOverviewSingle
obesity 33286 obesityHow to deliver high-quality obesity counseling in primary care using the 5As frameworkManaging obesity in general practiceTreatment of obesityObesityCountryCanadaUSAUSAUSAUSAUSAUKUSAUSAYear201220111995200519992012198320072010Overview/opinionOverviewOverviewOverviewOverviewOverviewOverviewSingle
obesity 33326 counseling in primary care using the 5As frameworkManaging obesity in general practiceTreatment of obesity ObesityCountryCanadaUSAUSAUSAUSAUSAUKUSAUSAYear201220111995200519992012198320072010Overview/opinionOverviewOverviewOverviewOverviewOverviewOverviewSingle
obesity 34611 help patients lose weight?How should the obese patient be managed? Possible approaches to a national obesity management networkAn integrated health care standard for the management and prevention of obesity in
obesity 34709 national obesity management networkAn integrated health care standard for the management and prevention of obesity in The NetherlandsReducing overweight and obesity: closing the gap between primary care and public healthObesity
obesity 34759 care standard for the management and prevention of obesity in The NetherlandsReducing overweight and obesity : closing the gap between primary care and public healthObesity and the overworked GPMedical home concept:
obesity 34923 healthObesity and the overworked GPMedical home concept: policy implications for an integrated approach in obesity managementPrimary care and public health a natural alliance? The introduction of the guidelines for
obesity 35031 managementPrimary care and public health a natural alliance? The introduction of the guidelines for obesity and undernutrition of the Dutch College of General PractitionersCurrent concepts in the management of
obesity 35141 and undernutrition of the Dutch College of General PractitionersCurrent concepts in the management of obesity : an evidence based reviewManaging obesity in primary care practice: a narrative reviewAssessment and
obesity 35183 General PractitionersCurrent concepts in the management of obesity: an evidence based reviewManaging obesity in primary care practice: a narrative reviewAssessment and lifestyle management of patients with obesity:
obesity 35288 obesity in primary care practice: a narrative reviewAssessment and lifestyle management of patients with obesity : clinical recommendations from systematic reviewsThe mission of Obesity Australia is to drive change
obesity 35426 systematic reviewsThe mission of Obesity Australia is to drive change in the public perceptions of obesity , its prevalence and its treatment.CountryUSAAustraliaAustraliaCzech RepublicNetherlandsSpainUKUSANetherlandsSaudi
obesity 36522 practitioner.Table 4Current practice articles on the role of the family doctor in the management of adult obesity in primary care (over three pages)AuthorBourn[204]Alexander et al[205]Alexander et al[206]Klumbiene
obesity 36749 al[208]Patterson et al[209]Hoyt[210]Fransen et al[211]Cohen et al[212]Fobi et al[213]TitleTackling obesity in EnglandDo the five A’s work when physicians counsel about weight loss?Weight-loss talks: what works
obesity 37397 care: a multilevel analysis of variation in the delivery of mental health, substance-use disorder, and obesity servicesThe development of a minimal intervention strategy to address overweight and obesity in adult
obesity 37490 disorder, and obesity servicesThe development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The NetherlandsLaparoscopic Roux-en-Y gastric bypass for BMI<35 kg/m2:
obesity 39033 clinical guidelinesGPs failing to offer weight-loss advice to people who need itTen-year follow-up of obesity Recognition and management of overweight and obesity in primary care in GermanyA silent response to the
obesity 39085 advice to people who need itTen-year follow-up of obesityRecognition and management of overweight and obesity in primary care in GermanyA silent response to the obesity epidemic: decline in US physician weight
obesity 39144 obesityRecognition and management of overweight and obesity in primary care in GermanyA silent response to the obesity epidemic: decline in US physician weight counselingWho gets what treatment for obesity? A survey of
obesity 39231 response to the obesity epidemic: decline in US physician weight counselingWho gets what treatment for obesity ? A survey of GPs in ScotlandAudit of the diagnosis and management of adult obesity in a Maltese general
obesity 39314 what treatment for obesity? A survey of GPs in ScotlandAudit of the diagnosis and management of adult obesity in a Maltese general practiceU.S. primary care physicians' diet-, physical activity-, and weight-related
obesity 40675 al[225]Morris and Gravelle[226]Huber et al[227]Asselin et al[228]TitlePrimary care’s ecologic impact on obesity GP supply and obesityObesity management and continuing medical education in primary care: results of
obesity 40696 Gravelle[226]Huber et al[227]Asselin et al[228]TitlePrimary care’s ecologic impact on obesityGP supply and obesity Obesity management and continuing medical education in primary care: results of a Swiss surveyMissing
obesity 41674 careXUnder-recognition/undertreatment mentionedXGP, general practitioner.Table 5International guidelines on the management of adult obesity in primary care, the role of the family doctor (FD) (over two pages)GuidelineCountryYearIntended for
obesity 42064 mentionedFD—advice on use of intensive treatmentsFD— referral to allied healthFD— referral to specialist obesity servicesDoes not mention specific role for FDRACGP SNAP— Overweight and obesity, 2nd edition[229]Australia2015XXXXXXXXNational
obesity 42146 referral to specialist obesity servicesDoes not mention specific role for FDRACGP SNAP— Overweight and obesity , 2nd edition[229]Australia2015XXXXXXXXNational Institute for Health and Care Excellence ‘Managing
obesity 42432 prevention of weight gain and use of behavioural and pharmacological interventions to manage overweight and obesity in adults in primary care Canadian Task Force on Preventive Health Care[231]Canada2015XXXClinical practice
obesity 42595 Preventive Health Care[231]Canada2015XXXClinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia[1]Australia2013XXXXXXXXXInstitute for Clinical Systems
obesity 43297 of Obesity in Adults: Recommendation Statement[235]USA2012XXXXXXXXXScreening for and management of obesity in adults: US Preventive Services Task Force recommendation statement[236]USA2012XXXXXRACGP guidelines
obesity 43779 Ministry of Health Services primary care providers have an important role in preventing and managing obesity through services offered to patients[239]Canada2011XXXWorld Gastroenterological Organisation: Obesity
obesity 44332 "Smoking, Nutrition, Alcohol, Physical Activity".What is the role of the family doctor in managing obesity as a primary risk as supported by the evidence base?The family doctor was involved in varying ways in
obesity 44442 a primary risk as supported by the evidence base?The family doctor was involved in varying ways in obesity management depending on the type of article. The most common role for the family doctor across all types
obesity 44588 article. The most common role for the family doctor across all types of articles was the diagnosis of obesity . The diagnosis was based on the BMI of the patient and waist circumference measurements were rarely
obesity 44922 about current practice, including audits and surveys, mentioned a lack of recognition and treatment of obesity by family doctors. Current overview and opinion papers often suggested a wide role including diagnosis,
obesity 45446 the guideline.In all types of articles, the family doctor was frequently involved in the diagnosis of obesity (73/110 intervention papers, 69/74 overview papers, 22/24 current practice papers). They were involved
obesity 47389 ongoing management after surgery.Overall, the family doctor was commonly involved in the diagnosis of obesity , and as a referral source into intervention trials. Frequently, the under-recognition and management
obesity 47501 as a referral source into intervention trials. Frequently, the under-recognition and management of obesity was noted in observational studies of current practice. It was difficult to identify the pillars of
obesity 47677 difficult to identify the pillars of primary care practice in the description on interventions for adult obesity management.What do primary care guidelines say about the role of the family doctor? What do peak bodies
obesity 49049 scoping review synthesises the current literature on the role of the family doctor in the management of obesity in primary care. This comprehensive set of articles provides the research community with a resource
obesity 49289 systematic reviews and meta-analyses based on different aspects of primary care management of adult obesity .The family doctor is mostly used as a recruitment source in primary care interventions, the majority
obesity 49748 articles that described current practice, mostly through clinical audits or surveys, reported that obesity was under-recognised by family doctors. There appears to be a misalignment between what commentators
obesity 50023 play in many primary care interventions.The great majority of primary care interventions for adult obesity are being developed and tested in the USA healthcare setting. This has implications for the interpretation
obesity 50714 investigation.We were also able to identify areas of concern for the publication of primary care research in obesity management. Twenty-seven of the interventions used standard care in the control arm, but standard care
obesity 50972 interventions. It is difficult to determine the relative effectiveness of new interventions in the management of obesity in primary care when they are compared with poorly defined standard care. More worryingly was the use
obesity 51419 dubious practice from an ethical and scientific perspective and undermines the role of family doctors in obesity management.Implications for practiceGuidelines are documents that are developed to assist practitioners
obesity 51654 of action in a specific clinical circumstance[19] and they often determine a standard of care. The obesity guidelines that were identified in this review had varying recommendations for the role of the family
obesity 52593 determining the clinical scope and responsibilities of specific professional groups such as family doctors in obesity care.Implications for researchPoor descriptions of interventions could have been aided by adherence
obesity 54610 could be added to the TIDieR checklist.LimitationsThis scoping review is limited to the context of obesity management in primary care. Articles that reported on other important and related topics like nutrition,
obesity 54816 nutrition, lifestyle change or cardiovascular health were not included. We chose to limit the review to obesity as we were interested in this specific literature and wanted to maintain the depth of our data extraction
obesity 56369 provides a platform for further interpretation of existing literature on the role of the family doctor in obesity management.Supplementary MaterialReviewer commentsAuthor's manuscrip

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