Vol 39 # 2 June 2007 - Kma.org.kw

June 2007KUWAIT MEDICAL JOURNAL 141encouraging positive behavior and identifyingtreatments .The GPs role includes treating obesityand its emotional and medical consequences [ 24 ] .More than 50% of the physicians were convincedthat obese patients were treated in the asymptomaticpopulation. A study in Te x a s [ 25 ] confirmed thatfamily physicians usually address issues ofnutrition and physical activity in asymptomaticobese adult residents. Then again, this studyshowed that 61% GPs had regular visits by obesepatients and more than 75% of those visits weredifficult to handle. This was confirmed by anotherstudy, where GPs thought that obesity was difficultto be handled in primary care practice [26] .The reasons for the alleged difficulties can beidentified in more depth. Firstly, there was highfailure rate in maintaining ideal weight. Severalstudies showed that success rates in reaching andmaintaining an ideal weight were low [27] . In thesame field, GPs rated that treatments of obesitywere less effective than other chronic diseases [28] .Secondly, there were time constraints. Differentopinion revealed that physicians although theyfaced ‘busy clinical practice settings’ at the primaryc a re clinics nevertheless they succeeded inproviding their patients with a variety of practicestrategies to combat obesity. The key to theirsuccess was based on enlightening each patientwith his or her risk factors. Furthermore, theyrecommended certain diets and encouragedpatients to become active participants in weightloss programs [29] .In reality, the most commonly recommendedtreatments for obesity are the increase of physicalactivities and the reduction in caloric intake. Astudy conducted in the U.S.A. showed that twothirds of physicians provided dietary advice andthree quarters of doctors found that dietary advicewas the responsibility of physicians [30] . In anothers t u d y, 99% of doctors recommended aerobic exerc i s e sand 97% provided dietary counseling [31] . To concur,obesity experts viewed that medications prescribedto obesity patients were less effective and could notreplace diets and exercises [32] . Similarly, this studyshowed that most of GPs preferred not to prescribeanti-obesity medications. Also, this can be due topoor safety profiles of these medications [33] .On the contrary, another study in Korea indicatedthat 68.8% of their physicians prescribed antiobesitymedication without allowing sufficient timefor non-pharmacological therapy to take its effect.This was due to their lack of training on obesitytreatments and management [34] .This study also declared that GPs frequentlyreferred their obese patients to dietitian. This can bedue to lack of time or because patients had beenunder the impression that dietitians provide morehelp than GPs. On the contrary, another studyfinding confirmed that GPs rarely referred obesepatients to health professionals like dieticians forfollow-up or treatment [35] . At the same time, GPs ina different study referred obese individuals whowere in greater need of losing weight or were lessmotivated or were less likely to accept treatmentsbut equally likely to profit from them [36] .As regards to surgical intervention, 94% of theGPs had rarely chosen this as a managementoption. Several studies agreed that surg i c a lp ro c e d u res were underu t i l i z e d [ 37 ] while othersreserved surgical intervention for those with moreserious clinical risks [38] .In Kuwait 86% of doctors did not recommendbehavioral therapy. This could have been due todifferent reasons. First, such therapy option wasnot widely available in Kuwait. Second, there was alack of interest in gaining experience in this field.Third, the therapy was not in agreement withcultural standards. Despite all these reasons, behavioraltherapy has proven positive results. It employedlong term behavior modifications to control impro p e reating habits and behaviors (like eating too rapidlyor eating while watching TV). This study confirmedsuch favorable results and strongly recommendedthis kind of reaction to obesity [39] .Only 33% GPs performed active counseling onobese patients. This low percentage could havebeen due to lack of experience or lack of training inthis field. Also, it could be due to the absence ofclear and specific primary care guidelines. Thoseguidelines were available in certain countries. Theresearchers in those countries suggested expandingthem to counsel obese patients. To elaborate, theguidelines must involve weight loss techniques andthe diff e rent ways of improving patient’s complianceand motivation [40] . Others have agreed that someGPs did not provide enough guidelines on weightmanagement strategies due to inadequate counselingskills and confidence [41] .At any rate, as shown clearly in this study,experience was ranked as the most importantcontributor to knowledge concerning managingobesity [42] .In general, several studies suggested that therewas a need for appropriate approaches andpractices toward obesity. In addition, more informationand training must be available to doctors andhealth professionals. This can be accomplished bykeeping up-to- date with related i n f o r m a t i o n .A d d i t i o n a l l y, seeking skills impro v e m e n tand gettingsocial support are highly recommended to makemanagement programs more effective [43] . Anotherstudy concluded that new strategies must be