As in the rest of the world, obesity in Oman has increased and according to World Health Organization (WHO) data, prevalence of obesity in 2008 and 2016 were 20.9% and 27% respectively. This study explores primary care physicians’ current strategies and management of obesity, attitude and perceptions towards obesity, educational needs, and their views on long-term follow up.
Methods: A cross sectional study was conducted where practicing family medicine physicians from different governorates were invited to participate in an online questionnaire-based survey. Participant were invited via email and responses were kept anonymous. Responses were collected over three weeks in April 2019 and only responses that met inclusion criteria were analyzed with SPSS v22.
Results: 77 complete responses met inclusion criteria and female were the majority (67.5%). Half of participants had less than 10 years of experience. Weight and BMI were recorded routinely by two-thirds of participants whereas waist- hip ratio was recorded by only 12%. Weight reduction medications were prescribed by 5.2% and 24% would refer an obese patient to Bariatric center. Main barrier to obesity management and referral was inadequate obesity specialist centers followed by short consultation times. The pathophysiology mechanism of obesity and related hormones was only known by 40.8%. Almost all participants agreed that formal obesity management training should be integrated as part of residency training.
Conclusion: Despite the significant number of comorbidities related to obesity and its complications, weight, BMI and other anthropometric measures were not routinely performed. Nationally, the rate of referral to bariatric centers for evaluation is low. Boundaries and challenges do exist and need to be addressed. Obesity and weight management need to be integrated as part of Family Physicians Training Program.
WHO Fact Sheet, Obesity and Overweight, 1st April 2020 (2020) Available at:https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
National Health and Medical Research Council (NHMRC). National Health and Medical Research Council Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. In: ed. Melbourne: National Health and Medical Research Council, 2013. Available at: https://www.omanobserver.om/omans-first-conference-on-obesity/
Knoema, World Data ATLAS (2016). Available at: https://knoema.com/atlas/Oman/Female-obesity-prevalence
MOH, 1st Oman Obesity Conference, Media Center 20/10/2018. Ministry of Health, Oman. (2018) https://www.moh.gov.om/en/-/---835
Oman STEP Survey, centre of Studies and Research, Ministry of Health, Oman (2017). Available at: https://mohcsr.gov.om/wp-content/uploads/2018/12/Fact-Sheet-1-Omani-Non-Omani-18.pdf
AljoudiA, Mwanri L, Al Dhaifallah A (2015) Childhood obesity in Saudi Arabia: Opportunities and challenges. Saudi Journal of Obesity, 3(1): 2-7.
Alexander SC, Ostbye T, Pollak KI, Gradison M, Bastian LA, Brouwer RJN. Physicians’ beliefs about discussing obesity: results from focus groups. Am. J. Health Promot. 2007;21(6):498–500.
J. Huang, H. Yu, E. Marin, S. Brock, D. Carden, T. Davis, Physicians’ weight loss counseling in two public hospital primary care clinics, Acad. Med. 79 (2) (2004) 156–161.
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384: 766-781
Stevens G, Global health risks: progress and challenges. Bull World Health Organ. 2009; 87: 646
Smith AW, Borowski LA, Liu B, et al. U.S. primary care physicians’ diet-, physical activity-, and weight-related care of adult patients. Am J Prev Med 2011; 41:33—42.
Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al.; Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults. Obes Facts. 2015;8(6):402–424.
Lau DCW, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E; Obesity Canada Clinical Practice Guidelines Expert Panel. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8): S1–S13
Zazai R, Wilms B, Enst B, Thunheer M, Schultes B. Waist Circumfrence and related anthropometric indices are associated with metabolic traits in severely obese subjects. Obes Surg. 2013;24(5): 777-782. Doi:10.1007/s11695-013-1141-6.
Sturgiss, E, Elmitt, N, Haesler, E et al 2018, 'Role of the family doctor in the management of adults with obesity: a scoping review', BMJ Open, vol. 8, no. 2, pp. 1-29.
Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168–77.
Shaw KA, O’Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2009; 2:CD003818.
Ahern AL, Wheeler GM, Aveyard P, Boyland EJ, Halford JCG, Mander AP, et al. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. Lancet. 2017 Jun 3;389(10085):2214-2225. doi: 10.1016/S0140-6736(17)30647-5. Epub 2017 May 3. Erratum in: Lancet. 2017 Jun 3;389(10085):2192. PMID: 28478041; PMCID: PMC5459752.
Colquitt, J., Picot, J., Loveman, E., Clegg, A., Surgery for obesity. Cochrane Database Syst Rev. 2009;2:CD003641.
Sikorski C, Luppa M, Dame K, Brähler E, Schütz T, Shang E, et al. Attitudes towards bariatric surgery in the general public. Obes Surg. 2013 Mar; 23(3):338-45. doi: 10.1007/s11695-012-0767-0. PMID: 22983771.
Avidor Y, Still CD, Brunner M, Buchwald JN, Buchwald H. Primary care and subspecialty management of morbid obesity: referral patterns for bariatric surgery. Surg Obes Relat Dis. 2007;3(3):392–407.
Hiddink GJ, Hautvast JG, van Woerkum CM, Fieren CJ & van `t Hof MA (1995): Nutrition guidance by primary-care physicians: perceived barriers and low involvement. Eur. J. Clin. Nutr. 49, 842 ± 851.
Aveyard P, Lewis A, Tearne B, Hood K, Christian-Brown A, Adab P, Begh R, et al. Screening and Brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. The Lancet Lancet 2016; 388: 2492–500. http://dx.doi.org/10.1016/ S0140-6736(16)31893-1.
Tsai AG, Histon T, Kyle TK, Rubenstein N, Donahoo WT. Evidence of a gap in understanding obesity among physicians. Obes Sci Pract. 2018;4(1):46-51. Published 2018 Jan 12. doi:10.1002/osp4.146.
NICE Obesity: identification, assessment and management of overweight and obesity in children, young people and adults; Available at: http://www.nice.org.uk/guidance/cg189/chapter/1-recommendations.
Moyer VA. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373-378.
STOP (Strategies to Overcome and Prevent Obesity) Obesity Alliance. Weight in America Survey. Harris Interactive. 2010
Kushner RF, Butsch WS, Kahan S. Obesity Coverage on Medical Licensing Examinations in the United States. What Is Being Tested? Teach Learn Med. 29 December 2016. doi: 10.1080/10401334.2016.1250641.
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