Counseling overweight in primary care: an analysis of patient-physician encounters.

OBJECTIVE: The aim of this study was to assess general practitioners' (GPs') and patients' practices and attitudes regarding overweight encountered during preventive counseling talks. METHODS: Twelve GPs audiotaped their preventive counseling talks with overweight patients, including the assessment of individual risk profiles and further medical recommendations. Fifty-two dialogues were transcribed and submitted to qualitative content analysis. RESULTS: Dietary advice and increased physical activity are mostly discussed during talks. Recommendations appear to be more individual if patients are given the chance to reflect on causes of their overweight during counseling talks. CONCLUSIONS: A dialogue approach affects the strength and quality of weight loss counseling in primary care. However, physicians and overweight patients rarely agreed on weight loss goals during the physician-patient talks. PRACTICAL IMPLICATIONS: Patient centeredness, particularly the integration of patients' perceptions towards weight management, might be an important step towards improving weight counseling in primary care.

[Overweight patients in primary care: how family physicians utilize medical check-up examinations for risk counselling. Content analysis of check-up counselling talks between physicians and patients]. / Ubergewichtige Patienten in der Hausarzt- praxis: Wie wird die Gesundheitsuntersuchung zur Risikoberatung genutzt? Eine qualitative Analyse von Arzt-Patient-Gesprächen.

BACKGROUND: The number of overweight patients in Germany has been continuously increasing during the past years. The so-called "check-up 35" consultation presents primary care providers with an opportunity for preventive counselling talks with the respective individuals. In this qualitative study we analysed family physician encounters. We were particularly interested in the way in which the subject matter was addressed and the risk counselling performed by the physicians when confronted with overweight patients. METHODS: Twelve physicians audio-taped their final check-up dialogue with 52 overweight or obese patients (BMI > or = 25 kg/m2). The interviews were transcribed, and a content analysis was conducted using the established method developed by Mayring. RESULTS: Physicians used direct or more often indirect strategies to address overweight in counselling talks that were most often initiated by their patients. They largely addressed this topic while communicating laboratory results. Some obese patients did not receive any advice on health risks. In the encounters analysed the physicians did not employ standardized risk counselling tools. CONCLUSIONS: The reasons for addressing overweight indirectly and the lack of standardized risk counselling with obese patients are carefully discussed.

Perception of stress and quality of life in overweight and obese people--implications for preventive consultancies in primary care.

BACKGROUND: The increasing prevalence of obesity requires especially primary health care providers to act. General Practitioners (GP) in particular have the opportunity to motivate patients in early risk stages to follow weight reduction programmes before manifestation of associated diseases. In order to conduct preventive consultancies it is necessary to explore the individual physical and mental health status of patients. Aim of this study was to examine quality of life and perceived level of stress in overweight and obese patients treated in primary care. MATERIAL/METHODS: 123 patients, following a health Check up realized by their GP, rated self- reported questionnaires regarding quality of life and perceived level of stress (SF-12, PSS). Following descriptive analysis, differences in dependent variables related to BMI, sex and age were tested using ANOVA and regression analysis (SPSSv15.0). RESULTS: Restrictions in all parameters of mental health for overweight and obese patients in primary care were shown. Especially patients with a BMI above 30 kg/m2 reported a decreased level of quality of life. CONCLUSIONS: Health care providers should be aware of cumulative restrictions in mental health of their overweight patients. The findings provide essential implications for all health care professionals in primary care doing preventive consultancies with obese clients.

Now I see it but you don't: 14-month-olds can represent another person's visual perspective.

Twelve- and 14-month-old infants' ability to represent another person's visual perspective (Level-1 visual perspective taking) was studied in a looking-time paradigm. Fourteen-month-olds looked longer at a person reaching for and grasping a new object when the old goal-object was visible than when it was invisible to the person (but visible to the infant). These findings are consistent with the interpretation that infants 'rationalized' the person's reach for a new object when the old goal-object was out of sight. Twelve-month-olds did not distinguish between test conditions. The present findings are consistent with recent research on infants' developing understanding of seeing.