Tackling obesity: the challenge of obesity management for practice nurses in primary care.

BACKGROUND Nurses in primary care, who see a large proportion of the population, are well placed to discuss weight with patients and offer management advice. Interventions to promote weight loss have shown that there are effective ways of making small changes for patients. OBJECTIVES To use qualitative semi-structured interviews to explore how practice nurses manage obesity within primary care and to identify good practice and explore barriers to achieving effective management. METHODS Eighteen semi-structured interviews were conducted with practice nurses within two local health board areas in South Wales. Interviews were audio-recorded, transcribed and analysed qualitatively using a thematic approach. RESULTS Nurses described two roles. One role was providing obesity management to patients who had co-morbid conditions and were seen regularly in chronic disease clinics. All nurses perceived that these patients needed their weight addressing routinely. The other role was to broach the subject with overweight but healthy patients. Nurses were of divided opinion whether to address obesity with these patients and what primary care had to offer. Weight management advice, when given, lacked consistency of approach. CONCLUSIONS Broaching the subject of weight opportunistically with healthy but overweight patients may require a deeper appreciation of their motivations for change and discussion beyond future health risks. These patients also need clearer follow up to monitor their progress with weight loss. All overweight patients also need clearer guidance tailored to their own particular circumstances as to how to lose weight. For patients being counselled about their weight, interventions that promote consistency of advice are advocated to improve care.