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Public Health and Public Policy

Overweight and Obesity: Knowledge, Attitudes,


and Practices of General Practitioners in
France
Aurelie Bocquier,* Pierre Verger,* Arnaud Basdevant, Gerard Andreotti, Jean Baretge,
Patrick Villani, and Alain Paraponaris*

Abstract
BOCQUIER, AURELIE, PIERRE VERGER, ARNAUD
BASDEVANT, GERARD ANDREOTTI, JEAN BARETGE,
PATRICK VILLANI, AND ALAIN PARAPONARIS.
Overweight and obesity: knowledge, attitudes, and practices of
general practitioners in France. Obes Res. 2005;13:787795.
Objective: To describe the current knowledge, attitudes, and
practices of French general practitioners (GPs) in the field
of adult overweight and obesity management.
Research Methods and Procedures: A cross-sectional telephone survey interviewed a sample of 600 GPs, representative of the private GPs in southeastern France. A four-part
questionnaire assessed personal and professional characteristics, attitudes and opinions about overweight and obesity,
relevant knowledge and training, and practices (diagnostic
methods, clinical assessments, weight loss objectives, types
of counseling).
Results: Most GPs knew that weight problems are healththreatening, and 79% agreed that managing these problems
is part of their role. Nevertheless, 58% did not feel they
perform this role effectively, and one-third did not find it
professionally gratifying. Approximately 30% had negative
attitudes toward overweight and obese patients; 57% were
pessimistic about patients ability to lose weight; 64% often
set weight loss objectives more demanding than guidelines

Received for review March 4, 2004.


Accepted in final form January 18, 2005.
The costs of publication of this article were defrayed, in part, by the payment of page
charges. This article must, therefore, be hereby marked advertisement in accordance with
18 U.S.C. Section 1734 solely to indicate this fact.
*Southeastern France Regional Center for Disease Control, Marseilles, France; Inserm
Research Unit 379 Epidemiology and social sciences applied to medical innovation,
Marseilles, France; Hotel Dieu Nutrition Department, University Paris 6, Paris, France;
Southeastern France Regional Union of Private Practitioners, Marseilles, France; Laboratory of Therapeutics, Department of Medicine, University of the Mediterranean, Marseilles, France; and Department of Economics, University of the Mediterranean, Marseilles,
France.
Address correspondence to Aurelie Bocquier, ORS PACA, 23 rue Stanislas Torrents, 13 006
Marseilles, France.
E-mail: bocquier@marseille.inserm.fr
Copyright 2005 NAASO

call for; and neither food diaries nor nutritional education


were used systematically. GPs feelings of effectiveness and
attitudes toward obese patients were associated with some
professional (training) and personal (BMI, personal diet
experience) characteristics.
Discussion: GPs feelings of ineffectiveness may stem from
an underlying conflict between practitioners and patients
representations of weight problems and the relationship
problems this causes. Inadequate practices and health care
system organization may also play a role.
Key words: obesity management, prevention, guidelines,
nutrition

Introduction
The pandemic of overweight and obesity in developed
and developing countries presents a challenge to public
health and requires medical intervention, modifications of
individual behavior, and environmental changes (1). Epidemiological studies in France, Spain, and Italy have shown
this disease striking the Mediterranean area, where food
habits have long seemed to protect against cardiovascular
risks (2,3). General practitioners (GPs)1 have a significant
role to play in preventing and diagnosing weight problems
and in providing initial counseling (4,5). They are, after all,
the health professionals consulted most often (6), and most
patients believe that their GPs couldand wish they
would help them to lose weight (7). Nonetheless, GPs do
not manage overweight and obesity satisfactorily, as they
themselves recognize (8 11): they identify only about onehalf of their overweight or obese patients (1214) and
advise only one-third of these patients to lose weight
(1517).

Nonstandard abbreviations: GP, general practitioner; CME, continuing medical education.

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GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 1. Demographic characteristics of the sample of respondents and of the population of private general
practitioners in Provence
General population of
GPs in Provence
(n 5435)

Sex
Male
Female
Age (years)
43
43 to 52
52
Size of practice area
(number of inhabitants)
2000
2000 to 200,000
200,000

Percentage

Percentage

2
tests

4140
1295

76.2
23.8

452
148

75.3
24.7

p 0.65

1398
2889
1148

25.7
53.2
21.1

158
305
137

26.3
50.8
22.8

p 0.50

357
1334
3744

6.6
24.5
68.9

52
150
398

8.7
25.0
66.3

p 0.13

GPs attitudes toward and practices in the management of


weight problems have been studied in various Englishspeaking countries (8,10,11,18), but we are aware of very
few published studies from Mediterranean countries (9). We
conducted a study of GPs in private practice in Provence
(southeastern France) to document their knowledge, attitudes, and practices regarding adult overweight and obesity
management.

Research Methods and Procedures


Sample
In March 2002, we set up a panel of GPs in private
practice in Provence to evaluate their medical and prescribing practices over a 3-year period. Specialists, GPs with
exclusive particular practices (e.g., homeopathy, acupuncture), and those planning to move outside the area or retire
were excluded. We stratified the sampling base according to
sex, age (43, 43 to 52, and 52 years old), and size of
practice area (2000, 2000 to 200,000, and 200,000
inhabitants) and randomly selected 1200 GPs from the
resulting strata to obtain a 600-GP sample representative of
the 5435 private GPs in Provence. Of these 1200 GPs, 1076
(89.7%) met the inclusion criteria, and 600 of 1076 (55.8%)
agreed to participate. Refusal rates were not significantly
different between strata.
From May to July 2003, we conducted telephone interviews of these GPs to document their attitudes about and
practices for overweight and obesity management: 580 of
600 (96.7%) participated, 12 of 600 (2.0%) withdrew, and 8
788

Sample of
respondents
(n 600)

OBESITY RESEARCH Vol. 13 No. 4 April 2005

of 600 (1.3%) could not be contacted. We replaced these 20


GPs with new physicians randomly selected in corresponding strata. The distribution of sex, age, and size of practice
area in our sample was similar to that of the regional GP
population (Table 1).
Questionnaire
To facilitate comparisons with previous studies, the
questionnaire was based on a review of the international
literature in overweight and obesity management in primary
care and on U.S. and French guidelines for identifying,
evaluating, and treating them (4,5). It was reviewed by a
group of experts (four nutritionists, one endocrinologist,
four physicians, and one sociologist) and pilot-tested with
17 GPs for length, clarity, and suitability. It included four
main parts.
Professional and Personal Characteristics. We assessed
the following characteristics: billing sector (in the controlled billing sector, the fee per consultation is set by the
Health Insurance Administration; in the noncontrolled billing sector, GPs freely set their own fees according to market
pressure and patient income), solo/group practice, subscription to medical journals, guidelines use, involvement in a
health network (coordinated group of several health professionals organized to improve health care in a specific medical field), and postgraduate medical degrees. We also asked
about their height and weight (for calculating their BMI),
personal experience of dieting, behavior related to food
intake, physical activity, and tobacco consumption.

GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Attitudes and Opinions about Overweight and Obesity.


Eleven items allowed us to examine GPs perception of
weight problems, involvement in their management, and
perception of their training, effectiveness, and professional
gratification in this field. Three items assessed their opinions about overweight and obese patients on a four-point
Likert scale (from not at all to strongly) including: do
overweight (obese) people tend to be lazier and more selfindulgent than normal weight people?; are overweight
and obese people able to lose weight and maintain that
loss? We included 17 items to assess GPs beliefs about
risk factors for and consequences of obesity and their views
of the importance of different outcomes as measures of
success in its treatment. We used a six-point Likert scale for
respondents to indicate the level of importance for each item
(1 not important, 6 extremely important).
Knowledge and Training in the Field of Overweight and
Obesity Management. GPs were asked 1) to estimate the
prevalence of overweight and obesity among French adults;
2) about health risks associated with obesity in adults (eight
risks, yes/no answers); 3) whether they were aware of the
guidelines for obesity management; 4) their main source of
relevant information [medical journals, continuing medical
education (CME), obesity management guidelines, computer programs/Internet, experiences described by patients,
dietitians/endocrinologists, mass media]; and 5) whether
they had medical training about weight management and
whether they felt they needed more training in various
aspects (counseling about nutrition or physical activities,
psychotherapy, behavioral therapy, drug treatment, surgical
treatment).
Practices in the Management of Weight Problems. Participants were asked about their practices at different stages
of weight management: diagnostic methods, clinical assessments, standard weight loss objectives and strategies, counseling about nutrition and exercise, follow-up, referral to
other health professionals, and perceived barriers to overweight and obesity care. Participants responded on a fourpoint Likert scale (from never or rarely to always or almost
always).
Survey Procedure
We used a computer-assisted telephone interview system
to question participants. Each interview lasted 30 minutes.
Data Analysis
Analysis began with simple frequency counts. We used
2 tests to examine differences between the sample and the
general population of GPs and to test differences in management for overweight and for obesity. We used the Fisher
statistic to examine the differences between mean scores of
various items (e.g., beliefs about causes of obesity). We
conducted simple and backward multiple logistic regression
analyses (entry threshold: p 0.15; exit threshold: p

0.10) to study associations between GPs professional and


personal characteristics, their opinions about their effectiveness in this field, and their attitudes toward obese people.
We used the Hosmer-Lemeshow goodness-of-fit test to
measure the fit of each model. Statistical analyses used
SPSS software (version 11.0; SPSS Inc., Chicago, IL).

Results
GPs Characteristics
Most GPs (82.8%) practiced in the controlled billing
sector, and 55.4% practiced in group practices. Only 44.8%
subscribed to medical journals, 69.7% consulted guidelines,
47.8% had postgraduate medical degrees, and 15.7% were
involved in a health network. The prevalence of overweight
among GPs [30%; 95% confidence interval (CI) 26.3 to
33.7] was close to that of the French adult population
(29.4%; 95% CI 28.9 to 29.9), but the prevalence of
obesity was lower: 3% (95% CI 1.8 to 4.6) vs. 9.6% (95%
CI 9.2 to 10.0) (19). Approximately one-third of GPs had
dieted (84% lost weight); 71.5% considered their eating
habits to be healthy; 76.9% reported exercising at least
weekly; 69.9% were currently monitoring their food intake
to lose or maintain weight; and 26% were current smokers.
GPs Attitudes Toward Overweight and Obesity
Most GPs regarded obesity as a disease and agreed that
their role includes weight problem management, but 57.5%
felt that they do not manage it effectively. Approximately
30% considered overweight and obese patients lazier and
more self-indulgent than normal weight people, and 57.2%
were rather pessimistic about these patients ability to lose
weight (Table 2).
The multiple logistic regression (Table 3) showed that
practice in the noncontrolled billing sector (p 0.01), CME
training about weight problems (p 0.01), awareness of
obesity management guidelines (p 0.02), normal weight
(p 0.05), and personal success in losing weight (p 0.01)
were associated with a feeling of effectiveness in this field.
Negative attitudes toward obese patients were associated
with not subscribing to any medical journals (p 0.03),
awareness of obesity management guidelines (p 0.03),
and never having dieted themselves (p 0.05; Table 3).
GPs rated food intake as a significantly more important
risk factor for obesity than stress, hormonal problems, or
unemployment. They also rated the medical consequences
of obesity as more important than its psychological and
social consequences (Table 4).
GPs Knowledge and Training in the Field of Weight
Control
Most GPs (51.2%) underestimated the prevalence of
overweight in the French adult population, whereas one-half
overestimated the prevalence of obesity. Nearly all recogOBESITY RESEARCH Vol. 13 No. 4 April 2005

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GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 2. GPs attitudes towards overweight and obesity (Provence, 2003)


Responses (%)
Statements

Strongly
disagree

Rather
disagree

Rather
agree

Strongly
agree

Obesity is a disease
Normal weight is important for health
For overweight and obese patients even small weight
loss can produce health benefits
Most overweight patients should be treated for
weight loss
Only obese patients should be treated for weight loss
Obesity management is necessary in the long term
GPs role is to refer overweight and obese patients
to other professionals rather than attempt to treat
them themselves
GPs should be models and maintain normal weight
I feel well prepared to manage overweight and obese
patients
Treating overweight and obese patients is
professionally gratifying
Obese people are lazier and more self-indulgent than
normal weight people
Overweight people are lazier and more self-indulgent
than normal weight people
Only a small percentage of overweight and obese
people can lose weight and maintain this loss

595
599

2.5
0.7

7.2
0.2

33.4
16.9

56.8
82.3

596

0.0

0.8

21.5

77.7

598
595
598

0.8
40.2
0.2

5.9
39.8
0.3

47.5
14.6
15.9

45.8
5.4
83.6

594
595

31.0
7.7

48.0
8.7

17.5
53.1

3.5
30.4

596

5.9

26.5

44.6

23.0

595

7.6

23.9

48.4

20.2

597

27.3

41.9

26.1

4.7

594

25.9

45.5

24.9

3.7

597

11.9

30.8

48.2

9.0

nized most health consequences of obesity (premature mortality, type II diabetes, sleep apnea, hypertension, increased
surgical risks, phlebitis), but 53% were unaware of the risks
of infertility, and 45.5% were unaware of the risks of some
cancers. Only 6.7% were aware of the guidelines for obesity
management. One-half reported that their main source of
information in this field was medical journals, 25.2% was
CME, and 10.4% was experience described by patients. Just
over one-half of the GPs (54.2%) had taken a CME class in
weight management, and 80% acknowledged they needed
more training, especially about nutrition counseling and
behavioral therapy.
GPs Practices
Most GPs (88.5%) often or always used BMI as a diagnostic method, whereas only 41% often or always measured
the waist (Table 5).
More than 90% of the participants often or always assessed
individual risk factors, physical activity, dietary habits, patients expectations and motivation, patients psychological
790

OBESITY RESEARCH Vol. 13 No. 4 April 2005

state, existence of food behavioral problems, and weight history; a lower but still high proportion (70% to 90%) often or
always assessed respiratory problems, venous and lymphatic conditions, joint diseases, calory intake, energy expenditure, and social status; 60% to 70% often or always
checked for hepatomegaly or steatosis, sleep disorders, and
pain; and 30% to 40% often or always assessed skin condition and looked for cancerous breast nodules.
One-half the sample (50.8%) set a loss of 5% to 15% of
initial weight as the objective for overweight patients. To
reach this goal, 23.2% often or always prescribed drug
treatment, 31.6% recommended psychotherapy, 14.8% recommended a behavioral therapy, and almost one-half included a spouse or a close relative in the treatment. Too
stringent treatment objectives for obese patients were set
by 64.3% of GPs (weight loss to normal BMI or 15%;
Table 6).
Nearly all participants (90% to 99%) gave traditional
nutritional advice (Table 5). Only 35% often or always
counseled avoiding specific foods, and 22% suggested very

GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 3. Determinants of GPs feelings of effectiveness and attitudes towards obese people (multiple logistic
regression with sex and age forced; Provence, 2003)
Model 1: feels effective in
management of weight
problems (n 578)
OR
Billing sector
Controlled billing sector
1
Noncontrolled billing sector
1.94
Medical journal subscription
Yes
No
Has taken a CME class about management of
weight problems
Yes
1.66
No
1
Knows guidelines for obesity management
Yes
2.35
No
1
Current BMI (kg/m)
Underweight or normal range (25)
1
Overweight (25 to 29.9)
0.59
Obese (30)
0.71
Has ever been on a diet
No
1
Yes and it succeeded
1.91
Yes but it failed
0.94
Hosmer-Lemeshow test
p 0.31

95% CI

p (Wald)

Model 2: thinks obese people


tend to be lazier and more selfindulgent than normal weight
people (n 591)
OR

95% CI

0.67
1

0.46 to 0.96

p (Wald)

0.01
1.22 to 3.08
0.03

0.00
1.17 to 2.36
0.02
1.13 to 4.86

0.03
2.15
1

1.10 to 4.20

0.05
0.39 to 0.90
0.24 to 2.13
0.01
1.25 to 2.91
0.38 to 2.32

0.05
1
0.64
0.55
p 0.95

0.41 to 0.98
0.16 to 1.17

Variables statistically not significant in univariate analysis: 1) any model: sex, age, solo/group practice, guidelines use, belongs to a health
network, postgraduate medical degrees, is currently monitoring his food intake, tobacco status; 2) model 1: medical journal subscription,
reports regular physical activity; 3) model 2: billing sector, CME class, current BMI, reports a healthy diet.
Variables statistically significant in the univariate but not the multivariate analysis: 1) any model: size of practice area; 2) model 1: reports
a healthy diet; 3) model 2: reports regular physical activity.
OR, odds ratio.

low-calorie diets; 36.2% never, rarely, or sometimes offered


nutritional education, and 60.7% never, rarely, or sometimes recommended that patients use food diaries.
Nearly all of the GPs saw these patients at least monthly,
and 40% often or always proposed a telephone follow-up
between consultations. Less than one-third referred patients
to other professionals, and only 31% often or always referred their overweight or obese patients to a dietitian.
The most common problems experienced by GPs in treating overweight or obese patients were lack of patient motivation (often or always encountered by 60.1% of partici-

pants), lack of support from patients relatives (57.1%), lack of


time (53.3%), nonreimbursement of consultations with
dietitians (51.3%), and patients nutritional knowledge
(39.2%).

Discussion
We found that most GPs believed their role in overweight
and obesity management is important but did not feel that
they performed it effectively. This observation is consistent
with results of other studies of GPs (8,9,11) and also,
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GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 4. GPs beliefs about obesity risk factors and


consequences and their perception of success in the
management of weight problems (in decreasing rank
order; Provence, 2003)

Risk factors
Eats too much fat
Eats too much
Eats too much sugar
Insufficient physical activity
Genetic factors
Repeated dieting
Stress. anxiety, and depression
Hormonal problems
Low income, unemployment
Consequences
Medical problems
Psychological problems
Social problems
Success indicators in weight problems
management
Adoption of healthier diet and
exercise habits
Weight loss to the normal BMI
range
Improvement of body image and self
confidence
Even small weight loss but longlasting
Improvement in clinical indicators

Mean*

SD

5.2
5.1
4.9
4.7
4.5
4.2
4.1
3.7
3.3

0.93
1.02
1.01
1.08
1.25
1.26
1.07
1.28
1.19

4.9
4.3
3.8

1.11
1.04
1.09

5.3

0.75

5.1

0.96

5.0

0.89

4.7
4.6

0.94
1.07

* Mean of GPs responses on a six-point Likert scale (from 1


not important to 6 very important).
Pairwise comparisons of means: p 0.05 except eats too much
fat vs. eats too much (p 0.38) and repeated dieting vs. stress
anxiety and depression (p 0.18); Pairwise comparisons of
means: p 0.05; Pairwise comparisons of means: p 0.05
except even small weight loss but long-lasting vs. improvement in
clinical indicators (p 0.12).

interestingly, of endocrinologists and internists (20). Several obstacles may explain this apparent contradiction.
Physicians and patients have different perceptive and
attitudinal models of weight problems, and one major obstacle may be the problem this creates in their relationship.
Our results suggest that GPs perceptions of overweight and
obesity are shaped by a model that blames the victim (21):
they perceive behavioral factors (food habits and physical
activity) as greater risk factors for obesity than genetic
792

OBESITY RESEARCH Vol. 13 No. 4 April 2005

factors or stress and unemployment; behavioral factors are


generally considered more controllable by the individual
than unemployment, for example (18). This model clashes
with patients views: they attribute more importance to risk
factors over which they have little or no control (21).
Moreover, one-third of the GPs had stereotypical and negative attitudes toward overweight and obese patients. Although these attitudes seem less prevalent among health
professionals than they were 30 years ago (22,23), they are
still held by 30% of GPs, internists, and cardiologists and by
a lower fraction of endocrinologists (9 11,20), and their
prevalence tends to increase with patient BMI (18,24).
Studies suggest that this basic disagreement may be associated with poorer patient outcomes (25,26) and that patients negative responses to these attitudes creates a vicious
circle that reinforces the doctors attitudes (24). Support for
this observation comes from the less negative attitudes and
greater feelings of effectiveness of GPs who have successfully lost weight themselves: personal experience may reduce the discrepancies between GPs and patients representations of the disease.
Because negative attitudes toward the obese and feelings
of effectiveness were not associated with age, it is unlikely
that either initial training or experience affected them substantially. Our results suggest, however, that appropriate
information may improve GPs attitudes toward and opinions about obese patients. GPs who subscribed to medical
journals were less likely to think that obese people tend to
be lazier than normal weight people, perhaps because they
were more aware that environmental obesity risk factors,
not controllable by patients, exist. Although guidelines
stress that GPs attitudes may affect the quality of their
patient treatment (4,27), awareness of the guidelines was,
surprisingly, associated with more negative attitudes, perhaps because awareness of the guidelines does not necessarily entail their use.
One striking finding was that the GPs substantially underestimated the prevalence of overweight and overestimated that of obesity. This suggests that they may rely
mainly on a therapeutic rather than preventive approach to
weight problems, an attitude that may delay management of
weight problems. A U.S. study showed that health care
providers advise relatively few overweight patients to lose
or even to not gain weight (16), although maintaining current weight is known to be easier than losing weight (4).
Some more specific practices may also impede satisfactory outcomes: 60% of GPs set stricter weight loss objectives for obese patients than recommended (4,5). This finding seems to be new: previously published results showed
that GPs have reasonable expectations about weight loss
(8,28). This result may be consequential because it may
reinforce unrealistic and unachievable weight loss goals that
may be a significant source of failure for patients (29 31).
One of the things patients want most from a primary care

GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 5. GPs practices in the field of adult overweight and obesity management (Provence, 2003)
Responses (%)
Practices
Diagnosis methods
Weight without reference to height
BMI
Waist/hips ratio
Waist measurement
Comparison with ideal weight (according to
Lorentz formula) (39)
Appearance
Weight management advice and tools
Eat less during meals
Eat less fat
Dont eat between meals
Eat less sugar
Eat more fruits and vegetables
Consume fewer caloric drinks
Definitely avoid specific foods
Follow personalized low-calorie diet (1200 to
2200 kcal/day)
Follow very-low-calorie diet (1200 kcal/day)
Follow commercial diet
Exercise (sports)
Do more exercise in everyday life (e.g.,
walking, gardening)
Leaflets on healthy behavior
Food diary
Nutritional education

Never
or rarely

Sometimes

Often

Always or
almost always

600
600
599
599

77.0
6.3
44.2
38.7

7.5
5.2
20.9
20.2

7.8
16.0
19.2
23.5

7.7
72.5
15.7
17.5

598
598

46.8
21.4

19.7
18.6

18.4
29.9

15.1
30.1

595
598
597
597
597
598
599

10.4
0.5
6.0
0.7
0.7
0.0
53.4

13.9
1.8
3.0
4.5
3.9
0.3
11.2

25.0
17.9
16.1
21.4
17.6
8.2
14.4

50.6
79.8
74.9
73.4
77.9
91.5
21.0

597
598
598
598

11.6
55.0
53.8
3.8

14.6
22.6
33.8
9.4

37.7
14.7
8.7
30.1

36.2
7.7
3.7
56.7

587
597
597
598

2.0
12.6
37.4
17.6

2.7
21.4
23.3
18.6

18.6
31.0
20.4
29.9

76.7
35.0
18.9
33.9

physician is help in setting realistic weight goals (7). GPs


should also help them to improve their body image and
self-esteem and make them aware that a small weight loss
can produce important medical benefits (30,31).
Additionally, participants nutritional counseling practices did not meet guidelines for successful dietary therapy:
36.2% rarely provided nutritional education, and 60.7%
rarely suggested use of a food diary (4,27). Thus, nutritional
management often seems limited to one-shot advice and
neglects tools that could help induce long-term behavior
modifications.
Beyond these barriers, other problems related to the
health care system must be considered, including time constraints, modes of reimbursement, and training content.
Most GPs in this study, as in others (32,33), reported
frequently lacking time, a problem known to be a significant
barrier to preventive care in general practice (34,35). Ex-

planations for patients, discussion of treatment and prevention, and health education require longer consultations. We
found GPs in the fixed-fee billing sector were less likely
to feel effective in overweight and obesity management.
The type of remuneration influences length of consultation
(36); therefore, GPs in this sector may have shorter consultations than the others.
GPs who had taken a CME course and were aware of
weight control guidelines felt more effective, probably because this training increased their self-confidence and convinced them that success is possible. The need for better
training in the field of weight control was recognized by
80% of the GPs in our panel and has been pointed out by
internists, endocrinologists (20), and gynecologists (37).
Analyses of potential associations between GPs age and
various practices and knowledge did not provide convincing
evidence that young GPs, who should have received better
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GPs Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 6. Objectives and strategies in the field of


overweight and obesity management (Provence, 2003)
Responses (%)
Overweight
Obesity
management management
Usual weight loss objective
No weight gain
Weight loss of 5% to 15%
of initial weight and its
maintenance
Weight loss of 15% of
initial weight and its
maintenance
Weight loss to the normal
BMI range
Management strategies (% of
often or always
responses)
Drug treatment
Psychotherapy
Behavioral therapy
Inclusion of a spouse or a
close relative in the
management

2.2

1.4

50.8

34.3*

14.0

45.0*

33.0

19.3*

23.2
31.6
14.8

40.5*
48.8*
24.2*

48.9

60.2*

* p 0.001.

initial training about nutrition and obesity management,


have better practices and are better-informed than their
older colleagues (results not shown).
Limitations
These self-reported data may not exactly reflect the reality of respondents attitudes and practices. GPs may be
reluctant to declare that obese patients are lazier than normal weight people, that they do not feel that they provide
effective treatment, or that they lack confidence in their
ability to counsel patients in this area. They may also have
overreported practices recommended by the guidelines,
such as BMI use for diagnosing weight problems. Moreover, because this study is cross-sectional, we cannot draw
causal inferences from the associations observed.
Conclusions
In summary, GPs felt that management of weight problems was one of their responsibilities. Although their diagnostic practices require improvement, most of their reported
practices follow the guidelines relatively closely. Neverthe794

OBESITY RESEARCH Vol. 13 No. 4 April 2005

less, like specialists, including endocrinologists and internists, most believed their treatment was of limited effectiveness, and one-third reported dissatisfaction with it.
Obstacles to satisfactory management seem to include GPs
attitudes and opinions and to some extent inadequate practices. In particular, we found, in a relatively new observation, that GPs set weight loss objectives for obesity management that were frequently too stringent.
A current reform of the French health care system will
give GPs a central role in health education and prevention.
Their attitudes and knowledge may thus determine whether
they can maintain this role and perform it effectively. However, organizational aspects, especially remuneration for the
time needed to implement prevention and education, must
also be considered: for example, the institution of incentive
fees for consultations for preventive and education purposes
might be useful. Assessment of these measures would then
be necessary (38). Facilitating work cooperation between
GPs and medical auxiliaries (such as dietician) might also
improve prevention and management of weight problems.

Acknowledgments
This work received technical and financial support from
the Southeastern France Regional Union of Private Practitioners (URML PACA) through the Southeastern France
Regional Union of Health Insurance (URCAM PACA)
Funds for Quality in Ambulatory Health Care (FAQSV).
We thank Drs. C. Colette, C. Fischler, M. L. Frelut, P.
Garandeau, M. Gerber, J. C. Gourheux, Jouret, P. Y. Lussault, M. Pellae, M. Rousseaux-Romon, M. Tauber, and H.
Thibault for invaluable help and advice and Jo Ann Cahn
for editorial assistance.
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