Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives
Permanent link to Research Commons versionhttps://hdl.handle.net/10289/16305
Obesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context. The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future. This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice. The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management. This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted.
The University of Waikato
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