Ms Claire Pearce1,2,3, Professor Andrew Wilson2,3, Professor Lucie Rychetnik2,3
1Canberra Health Services, Canberra, Australia, 2The Australian Prevention Partnership Centre, Sydney, Australia, 3University of Sydney, Menzies Centre for Health Policy, Sydney, Australia
Introduction: Obesity continues to have a significant impact on health services with people with obesity tending to access healthcare services more often and having longer lengths of stay. The literature supports health care based obesity prevention in the form of screening for obesity followed by referral to appropriate intervention services. Health professionals do not typically adopt this practice. The key practical barriers are time, knowledge and resourcing. The delivery of services is also influenced by personal perceptions.
Objective: The aim of this study was to utilise systems thinking to examine how perceptions of obesity and prevention at a policy, management and clinical level may influence how prevention is integrated into healthcare delivery.
Method: A sample of ACT public health service policy, management and clinical staff were interviewed to ascertain their perceptions of obesity and the role that health services could play in obesity prevention. The data was analysed using grounded theory.
Results: Two major concepts were observed in the data. The first related to the notion of obesity as a disease which encompassed perceptions of stigma, individual responsibility and the effectiveness of prevention. The second main concept related to the differences in paradigms that influence the health service response to obesity. Staff responsible for policy expressed a negative view towards obesity and a sense of nihilism, that obesity prevention is too late by the time people present to health services. Managers were less judgmental of obesity but expressed a degree of futileness towards prevention, highlighting a need to focus on the practical issues of caring for obese people and the immediate priorities of providing treatment. Clinicians expressed empathy towards overweight people and regularly incorporate opportunistic prevention into treatment despite an absence of clear policy direction contributing to a sense of helplessness.
Discussion: The reality of working with individuals on a one-to-one basis in a healthcare setting provides a different perspective to the population health view of obesity. Consideration needs to be given to how different parts of the system can input into policy and service development in order to develop the role of health services in the prevention of obesity.
Claire is an occupational therapist who works as a senior project officer with the Chronic Disease Management Unit based at Canberra Health Services. She has a Masters of Health Sciences from the University of London. Claire is undertaking her PhD at the University of Sydney supported by a scholarship from the Australian Prevention Partnership Centre. Her research is investigating the role of health services in the prevention of obesity.