European Journal of General Practice

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/igen20

Attitudes, behaviours and strategies towards

obesity patients in primary care: A qualitative
interview study with general practitioners in
Germany

Julian Wangler & Michael Jansky

To cite this article: Julian Wangler & Michael Jansky (2021) Attitudes, behaviours and
strategies towards obesity patients in primary care: A qualitative interview study with
general practitioners in Germany, European Journal of General Practice, 27:1, 27-34, DOI:
10.1080/13814788.2021.1898582

To link to this article: https://doi.org/10.1080/13814788.2021.1898582

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EUROPEAN JOURNAL OF GENERAL PRACTICE
2021, VOL. 27, NO. 1, 27–34
https://doi.org/10.1080/13814788.2021.1898582

ORIGINAL ARTICLE

Attitudes, behaviours and strategies towards obesity patients in primary

care: A qualitative interview study with general practitioners in Germany
Julian Wangler and Michael Jansky
Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany

KEY MESSAGES

Many GPs show a lot of sensitivity in treating and supporting obese patients, but different emphases stand
out: diet, exercise, psychosocial support, prevention.

However, some GPs show a sceptical approach.

Strategies such as motivational consultation and the effort to engage with patients play a central role in
long-term treatment outcomes.

ABSTRACT ARTICLE HISTORY

Background: Obesity poses severe challenges for the health care system. GPs are in an advanta- Received 15 September 2020
geous position to contribute to preventing obesity by diagnosing patients and initiating treat- Revised 17 February 2021
ment. Sporadic studies have shown that attitudes towards obesity management in primary care Accepted 22 February 2021
can have a major influence on treating patients successfully.
KEYWORDS
Objectives: The study focuses on attitudes and behavioural patterns towards obesity patients, Obesity; overweight;
willingness to provide care, approaches and strategies, and the challenges experienced. general practitioner;
Methods: After developing the interview guides based on a literature review, 36 GPs in North primary care; treatment
Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March
2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The
dimensions of the interview guides were used for deriving the prototypes.
Results: GPs were categorised into four types depending on how they saw themselves and their
role in treating patients. The first type (the resigned) was conspicuous through its negative atti-
tude towards obesity management and a lack of willingness to provide care. The second type
(the instructors) emphasised the value of active exercise, diet and health promotion, while the
third type (the motivators) saw psychosocial support and motivation as a key element in help-
ing patients. In contrast, type four (the educators) focussed primarily on early prevention
through patient education.
Conclusion: Depending on which (proto-)type a patient visits, different focuses and strategies
are pursued for obesity management and doctor–patient communication. This results in differ-
ent perspectives and chances of success about therapeutic measures.

Introduction problems and obesity are increasing in most of the

European Union states, with estimates of 52% of the
Obesity and overweight have been increasing in the
EU’s population (18 and over) overweight in 2014 [1].
European population [1]. Obesity in particular has
Obesity is assumed to play a dominant role in
been gaining focus as a chronic disease with limiting around 80% of type 2 diabetes mellitus cases, 35% of
effects on quality of life as well as high levels of mor- ischaemic heart disease cases, and 50% of hyperten-
bidity and mortality [2]. In Germany, 53% of adults are sive disease cases in Europe [4]. The negative psycho-
currently overweight (BMI 25–29.9 kg/m2), of which logical effects on those affected should not be
17% are obese (BMI >30 kg/m2) [1,3]. Weight underestimated either [2,5–7].

CONTACT Julian Wangler julian.wangler@unimedizin-mainz.de Centre for General and Geriatric Medicine, University Medical Centre Mainz, Am
Pulverturm 13, Mainz, 55131, Germany
Supplemental data for this article can be accessed here.
ß 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
28 J. WANGLER AND M. JANSKY

Due to their role in primary care, general practi- focuses on attitudes and behavioural patterns
tioners treat their patients in a holistic, comprehen- towards obesity patients, willingness to provide care
sive and continuous way to be well aware of the and support, approaches and strategies, and the chal-
patients’ background. Consequently, they are ideally lenges experienced. Suggestions for improved
placed to contribute towards preventing obesity by approaches will be derived from the collected data.
diagnosing patients and initiating treatment in a
timely fashion. They have a variety of options to
Method
reduce bodyweight in their patients through a
change in lifestyle and positively impact long-term Concept of the study
compliance and motivation [8]. These options include Since little is known about attitudes and behavioural
consultation on exercise and diet, therapeutic inter- patterns amongst general practitioners in treating
vention and arranging external healthcare services. obese patients there is a need for a broader explor-
Patients requiring additional psychosocial stabilisation ation of this issue. Consequently, a qualitative
may also be referred to psychological intervention. approach with semi-structured interviews appeared
Treatment options using drugs and surgery may also most appropriate. On the one hand, the topic could
be taken into consideration [1,9]. be researched as impartially as possible for new
Studies have shown that obese and overweight aspects, and on the other hand, interviews offer GPs
patients are more frequently motivated towards the opportunity to present their points of view and
losing weight if they consult with their GP about experiences in detail.
their bodyweight [10,11]. However, there is evidence
that only some general practitioners give actual
recommendations or instructions on diet and Ethics
exercise after diagnosing overweight or obes- During this study, no sensitive patient data were gath-
ity [12,13]. ered or clinical tests performed. All 36 expert inter-
Severely overweight patients are often dissatisfied views with general practitioners were strictly
with the care given by general practitioners [14]; con- anonymised. However, the authors of the study con-
versely, European studies have shown broad scepti- tacted the Ethics Commission of the State of
cism amongst GPs regarding motivation and discipline Rhineland-Palatinate before beginning the study to
towards sustainable bodyweight reduction in their ensure that it conformed with the medical profes-
patients [15–18]. This results in a major shift of sional code of conduct. The researchers identified the
responsibility for bodyweight reduction towards participants and requested their written consent to
patients [19,20]. In support of this analysis, one participate in the study.
German-language study found that general practi-
tioners take a more passive role in treating obesity
because they see a lack of patient motivation as the
Recruitment and sampling
greatest hindrance to successful treatment [21]. The general practitioners interviewed in this study
Qualitative studies from the UK and Portugal indicate have their practice in the federal states of North
insensitive and inconsistent communication from doc- Rhine-Westphalia and Saarland, Germany. As part of a
tors and latent stereotyping with severe impact on qualitative exploratory approach, a limited number of
the obesity condition [17,22]. GP trainees are also practices in both federal states were contacted,
sometimes affected by low confidence regarding although they were systematically selected. First, a
obesity management [23]. pool of 72 potential contact addresses was set up,
Other causes for reticence amongst general practi- including a wide range of general practitioners in
tioners towards obesity management include a sub- both federal states. Subsequently, the recruitment of
stantial lack of adequate primary care programmes or the sample took place. By using predefined quotas,
funding for nutrition, exercise and drug treatment emphasis was placed on ensuring that certain charac-
coverage from Germany’s statutory health insurance teristics are equally represented in the sample (gender,
funds [1,5]. office type, office environment). In addition, attention
Mostly in German-speaking countries there is a was paid to a broad geographical distribution of doc-
lack of studies on attitudes towards obesity manage- tors’ offices and the representation of different age
ment and possible explanations for apparent behav- groups as well as various qualifications and training
ioural patterns in primary care [1,21]. This work backgrounds (Table 1).
 EUROPEAN JOURNAL OF GENERAL PRACTICE 29

Table 1. Sociodemographic characteristics of the sample (N ¼ 36).

Office type 17 joint offices, 19 single offices
Office environment 12 in small towns or rural communities, 14 in medium-sized towns, 10 in cities
Employment type 24 offices owned by the GP, 12 GPs in employment
Age Ave. 54 years
Gender 18 male, 18 female
Previous knowledge and qualifications 8 from further training, 7 from additional training in sports medicine, 3 from additional training
in psychotherapy or psychoanalysis

A total of 49 physicians were contacted via tele- that an object area is divided into groups or types
phone or e-mail, with 36 interviews finally being car- based on defined characteristics. In terms of content,
ried out. The interviews took place between each type is defined along certain comparative dimen-
November 2019 and March 2020 and were conducted sions (indicators) with certain characteristics; so certain
by two general practice researchers, each conducting common characteristics and properties are within
half of the interviews. Each interview was carried out each group.
either in person or by phone and lasted between 40 The type formation procedure takes place in four
and 90 min. Table 1 provides an overview of the par- general stages: Developing relevant comparison
ticipating samples. dimensions (indicators); grouping of cases and analysis
of empirical regularities; analysis of contextual con-
Investigation tools texts and type formation; characterisation of the
derived types.
The interview guides were developed based on a lit- The central dimensions of the interview guides,
erature review [10,12,14,15,22]. In the course of the self-perception/role and behavioural pattern, were
first interviews, the instrument was further specified. used as indicators for deriving the types. Therefore,
The interview guides consist of 24 superordinate they define the within-group similarities and at the
questions with several sub-questions and primarily same time the between-group differences.
focussed on the following topics: comprised causes of It is important to note that the final types each rep-
obesity; attitudes towards the condition; identification, resent a prototype, meaning a basic pattern in terms
patient approach and education; role and self-percep- of attitudes and behaviour towards obesity patients.
tion with regard to obese patients; (long-term) therapy
support and willingness to treat; preferred approach
to obesity management; care and the challenges expe- Results
rienced; subjective assumptions and experiences on
Four different types emerged from the interviews
efficacy; cooperation with other care services. Personal
(Figure 1).
positions and previous experiences were not included
The first type (the resigned) was widely represented
(Supplementary Appendix 1).
in the sample and conspicuous through its negative
attitude towards obesity management, the patients
Data analysis affected, willingness to provide treatment, and
In qualitative research, theoretical saturation is assumptions on the general practitioner’s options in
achieved when collecting further data and its analysis making an improvement.
do not reveal any new aspects of a category system The other three types showed a more open-minded
and, thus, no longer reveal any new findings. This and proactive approach to dealing with obesity
became apparent after 36 interviews. patients, albeit to varying degrees. These general prac-
The analysis was based on qualitative content ana- titioners regarded primary care as an important part
lysis using MAXQDA software [24]. Types of general of a patient’s journey towards weight reduction. The
practitioners were formed during the analysis; this second type (the instructors) emphasised the value of
helped improve the assessment of the differences active exercise, diet and health promotion while the
between the interviewees regarding their self-percep- third type (the motivators) saw psychosocial support,
tion and how they understood their role as well as stabilisation and motivation as a critical element in
behavioural patterns in obesity management. In doing helping patients in the long term. In contrast, type
so, the empirically founded type formation according four (the educators) focussed primarily on early pre-
to Kluge was applied [24]. A type formation means vention of severe obesity through patient education.
30 J. WANGLER AND M. JANSKY

Cluster 2: Cluster 3: Cluster 4:

Cluster 1:
The The The
The resigned Obesity as a Obesity as a Commitment
Obesity as a instructors movators educators
product of life product of life to prevenve
personality issue
circumstances circumstances approaches

General Prevenon of
Movement and Psychosocial obesity by early
praconers
diet programme support, paent
giving advice
with close movaon and educaon
experienced as
support encouragement
fule
Cooperaon Networking with
Tendency to Check-ups and
with local psychosocial
delegate connuous care
services in services
paents to
encouraging
specialists
exercise

Figure 1. General practitioner prototypes within the sample.

Type 1: The resigned characteristics, general practitioners of this type also

lay the responsibility for weight loss on the patient.
A third of the sample (12) followed a resigned or
Years of frustrating experience in this group has led
negative approach with regard to treating obesity
them to doubt whether general practitioners can man-
patients, owing largely to the negative key experien-
age this type of patient effectively. Instead, they see a
ces they reported. Some of the interviewees went as
role for specialists using drugs, psychotherapy or pos-
far as stereotyping, emphasising that obesity was ‘not
sibly surgery as the final option.
a disease like any other’, but mainly due to character
predisposition involving living to excess or the ‘urge
to let themselves go’. Type 2: The instructors
I’ll say it straight out: It’s often their fault. [ … ] All they The second type comprised general practitioners who
do is eat and sit in front of the TV, they never restrain saw obesity mainly as a combination of life circum-
themselves, they can’t be bothered to do anything
stances and predisposition. These GPs took early diag-
about their hypertension and so on. [ … ] Everyone has
to take responsibility. (I-09-m) nostics seriously and preferred a structured exercise
and diet programme for their patients. They also
These general practitioners experienced severely reported successful outcomes from this treatment.
overweight and obese patients as unwilling to take
advice, ‘regularly getting nowhere’ initiating a change I see plenty of exercise and, most importantly, on a
regular basis as the correct approach in combination
in attitude and lifestyle, whether through diet or exer- with a healthy high-fibre diet. Patients need to be
cise therapy. Instead, the interviewees reported a lack started on a corresponding programme; that will lead to
of compliance and many setbacks in therapeutic inter- success sooner or later as long as it is strictly adhered
vention resulting in long-term severe medical prob- to. (I-31-f)
lems and increased mortality risks as well as One particularly prominent feature: These general
‘frustration and jadedness with this type of patient’ on practitioners were integrated into a local exercise
the part of general practitioners. and health promotion network alongside having
Many just won’t listen to medical advice, high-risk informal local contacts to draw on. This especially
patients and walking time bombs. [ … ] What can I do applies to collaboration with gyms and fitness
about it? With the best will in the world, you can’t get centres, self-help groups along with diet and health
them interested in making any changes; they don’t have
consultants. They saw the possibility of easily arrang-
any motivation towards changing anything in their
lifestyle. (I-02-m) ing reliable sports and health activities for patients as
essential in providing adequate support for their
There were indications for communication with obesity patients.
obesity patients occasionally turning harsh and disres-
pectful. There was a recognisable lack of willingness There isn’t anything you can achieve on your own as a
GP. You have to see yourself as part of a structure. This
to look for new ways and solutions for the patient to structure takes a lot of personal investment at the
lose weight or advise the patient on the importance beginning. [ … ] You can refer your patients with severe
of regular exercise and proper diet. By placing the obesity to good local partners without much trouble. (I-
blame for the condition on patient’s individual 08-m)
 EUROPEAN JOURNAL OF GENERAL PRACTICE 31

These interviewees did not show much interest in with their involvement in local sports opportunities,
continuous patient consultation at close intervals. networking also played a prominent role in this group
Instead, they saw a priority in a ‘focussed and concen- – albeit more in the field of psychosocial care and
trated jump-start’ to ‘set the scenes for consistent and support services. The interviewees also used these
gradual weight loss’ in an individually matched motiv- services if they believed their obesity patients would
ational exercise programme. Once this phase has been benefit from additional assistance.
mastered and an increase in exercise and healthy diet Many of these people suffer from depression; they feel
has been achieved in the patients’ everyday life, these uncomfortable with themselves and have low levels of
general practitioners give them more responsibility. self-esteem and confidence [ … ]. This is where we have
to start. [ … ] Not everyone needs psychotherapy.
Once you’ve managed to get the patient to accept their
Meeting other people going through the same thing
change in lifestyle as a matter of course without
often helps. (I-03-f)
relapsing into their old habits, long-term weight
reduction will follow. (I-16-f)

Setting a fixed weight loss target was seen as less Type 4: The educators
important than empowering patients to manage the
This fourth type appears as a variation on the two pre-
change and alter their habits. These interviewees also
vious ones. The general practitioners in this group
saw health apps as beneficial for motivation and daily
also actively provided care and arrange treatment rea-
routine. The use of drugs and surgical procedures is
sons for their obesity patients. Still, interviewees in
vehemently rejected, as the interviewees see the risk
this group were far more sceptical as to the success of
of yo-yo effects. The only exception should be acute
such treatment compared to the other two groups.
medical emergencies.
They believed that a long-standing case of obesity
had ‘already caused damage’ and was ‘not easy to get
Type 3: The motivators rid of’. Therefore, they saw it as far more important to
The third type also rejected the use of drugs and sur- deal with the condition earlier on and prevent the
gical procedures to achieve a substantial weight loss. development of severe overweight in their patients by
But unlike ‘the instructors’, these interviewees saw pointing out risk factors early, thus bringing about the
their main task in providing intensive psychosocial conditions for a healthy lifestyle. Interviewees in this
support for their patients. In their opinion, motivation group took health check-ups as an early warning sys-
and encouragement help develop the gradual realisa- tem very seriously, and some had undergone further
tion amongst patients that it would be beneficial for training in nutritional medicine.
them to change their lifestyle. The interviewees in this Patients on a poor diet with low exercise today are the
type held the opposite attitude to those in the first obesity cases of tomorrow. I think we have one of the
type (‘the resigned’). health system’s major deficits here. We need doctors
that adhere to the prevention aspect as a matter of
Nobody chooses to be fat or feels comfortable about it. course without necessarily telling their patients how to
This may be a question of predisposition or pre-existing live their lives. I mean just this awareness in the
conditions in some individual cases, but in most cases population. (I-05-m)
it’s due to longstanding social and psychological
processes. Stress at work or adverse life events. [ … ] These interviewees raise the question of how it is
That’s why it’s so important for the GP to allow the possible that patients often only come into the focus
patient to reveal the cause. To help them to help of (primary) care after years of obesity.
themselves, as it were. (I-17-f)
If someone’s obese, then something has already gone
These interviewees considered sensitive communi- wrong on the medical side. These people should have
cation and a collaborative approach to the doctor–pa- been noticed earlier and given the proper care
tient relationship as important. From their perspective, beforehand. So anything that might help us identify
these people earlier would be welcome. (I-07-f)
it is essential to give obese patients enough time for
consultation and always remain accessible to them, GPs of this type placed a high value on regular
even when treatment setbacks occur. Three interview- patient contact with consistent education and regular
ees in this group had undergone additional training in check-ups. Continuous bloodwork would also help
psychotherapy and psychoanalysis and believed that identify early risk factors for general practitioners to
this knowledge played a valuable role in successful watch out for. These interviewees also involved their
long-term obesity management. Like ‘the instructors’ practice staff for support. Here, parts of the practice
32 J. WANGLER AND M. JANSKY

staff were specially trained on the subject of obesity. showing a sceptic or dismissive attitude towards obes-
In some cases, members of the staff take on tasks in ity patients (Type 1: The resigned). This study aimed
counselling, for example, when it comes to referring not to detect any specific stigmatising attitudes, but
patients to further help services or giving advice on some of the interviews revealed latent or explicit ster-
healthy eating. eotyping against obesity patients (especially type 1).
The lack of readiness to provide care begins with the
attribution of low self-discipline and readiness to
Additional findings
make lifestyle changes; the cause for overweight is
Respondents from all clusters agreed that successful mainly seen in the patient’s personality, such as in
obesity patient management was often time-consum- lack of willpower.
ing, requiring a high level of medical commitment
with new attempts at treatment after previous
attempts had failed. They also objected to the severe Comparison with prior work
lack of supporting structures and care services for pre- This study’s results support general findings from this
venting obesity and managing treatment in primary research field, indicating that obesity is a highly polar-
care. There were repeated statements that GPs were ising disorder amongst doctors and that the differen-
often left on their own in caring for and treating obes- ces in attitudes will lead to differences in the degree
ity patients. They pointed out a lack of informal serv- of willingness to provide care and treatment [7,22,25].
ices for consultation and motivation especially in rural Previous studies have already noted that general prac-
areas. Close-knit networks for dementia had grown in titioners are often reticent in taking a proactive role in
many of Germany’s federal states but there was noth- obesity management as they perceive a lack of patient
ing similar for obesity. In addition, many doctors inter- motivation as a serious hindrance [21]. In some cases,
viewed openly admitted that they did not have a pronounced stereotypes and stigmatisations can be
satisfactory general picture of existing services as observed on the part of doctors [15,16,18]. The pre-
there was no fast and straightforward way of navigat- sent study results point to the work of Teixeira and
ing through the services available. Apart from that, colleagues, in which the attitudes of Portuguese GPs
some interviewees wished for an obesity disease man- to obesity management were examined [17]. Here,
agement programme to be initiated with more intense most doctors expressed the feeling that they are not
institutionalisation of this disorder since the number making any difference in getting their patients to
of obese patients increases. make long-term lifestyle changes; they tend to blame
obese patients as unmotivated and not-compliant,
Discussion very similar to the first type in the present study (the
resigned). A Canadian survey of 400 general practi-
Main findings tioners comes to similar results [18]. Another common-
The interview results showed a high readiness and ality between the present study and the work of
sensitivity among most general practitioners treating Teixeira et al. [17] is that GPs feel left alone to a cer-
and supporting overweight and obese patients. Even tain extent when caring for obese patients; the desire
so, varying strategies and emphases emerged towards for more referral options is expressed.
stabilising and motivating patients. One group focuses In contrast to the studies mentioned, there is a
more on early and consistent dietary adjustment and large part in the present sample (types 2–4) that
exercise (Type 2: The instructors), while another group shows great openness and activity in obesity manage-
concentrates more on psychosocial support (Type 3: ment. The best practice examples found in the course
The motivators). Especially worth emphasising are the of the interviews reveal the considerable potential of
interviewees integrated into informal networks with primary care. They support the widespread assump-
local gyms and exercise services or psychosocial and tion that, due to their role as trustworthy and long-
behavioural therapists depending on their chosen term primary care providers, GPs are predestined to
approach. Another type focuses on preventing severe care for overweight patients and to positively influ-
overweight by pointing out risk factors early, thus ence them through therapeutic and communicative
bringing about the conditions for a healthy lifestyle measures [10–13]. As Whitlock et al. [8] point out, GPs
(Type 4: The educators). have a variety of options to reduce bodyweight in
Although the findings were mainly positive, the their patients through a change in lifestyle and posi-
interviews revealed a substantial number of GPs tively impact long-term compliance and motivation.
 EUROPEAN JOURNAL OF GENERAL PRACTICE 33

The present study results show that it ultimately Implications

depends on each individual GP to what extent they
Some general practitioners tend to see the causes of
embrace the clinical picture of obesity and what prior-
obesity in the patient’s personality. Therefore, it seems
ities (instruction, motivation, education) they set to
advisable to raise awareness among GPs that obesity
make a difference. A central prerequisite for this is
can have as complex background involving factors such
open-mindedness to obese patients and the willing- as life circumstances and pre-existing conditions [1,3,5].
ness to collaborate with other organisations and disci- Within the sample, best practice examples can be
plines, just as a mixed-methods study on primary found for motivational consultation and the effort to
prevention in Germany showed. According to this engage with patients in their personal situation. Such
study, GPs considered (primary) prevention within behavioural treatment strategies can play a central
their realm of responsibility but they saw it ‘as the role in long-term treatment outcomes [12].
responsibility of multiple actors in a network of soci- Some interviewees took early diagnostics seriously
etal and municipal institutions’ [26]. The interviewees and preferred a structured exercise and diet pro-
of the present study were open to involving other gramme. This combination of diagnostics and recom-
occupational groups for the most part. mendations is crucial according to existing guidelines,
Furthermore, the present study results reflect defi- which provide additional assistance [27].
cits in the structures of obesity care that are perceived General practitioners should be encouraged in their
by all types. As several studies have shown [12,14,15], role as mediators by referring their patients to an
there is currently a lack of structured approaches in extended healthcare network, including psychothera-
treating obese patients with continuous support from pists or dietary assistants [28]. For example, health
general practitioners in lifestyle change. authorities often provide a useful guide to the local
training and consultation services available.
As suggested by several GPs in the study, develop-
ing structured care programmes for obesity manage-
Strengths and limitations ment seems sensible. These programmes should aim
This interview study revealed a variety of limitations towards improving patient care and training for GPs
that require further consideration. The GPs interviewed and their practice staff. International model projects
were recruited from a specific region (North Rhine- may provide guidance and could be adapted to suit
Westphalia and Saarland, Germany). It is also worth the specific situation [27–30].
considering that more general practitioners with a Ideally, general practitioners should be placed in a
specific interest in this topic could have taken part. position where they can fulfil two main tasks – individ-
A unique feature of the study is that the derivation ual consultation and treatment as well as coordination
of prototypes enables a more fundamental overview within a multidisciplinary obesity care network [26,28].
of attitudes and behavioural patterns of GPs when it
comes to obesity management. Yet, the selected Conclusion
method of type formation must be considered self-
GPs can play an important role in caring for obese
critically. As already mentioned, the aim here was to
patients. This applies to both motivating communica-
compress the data material in order to represent pro-
tion with patients and (therapeutic) measures. The
totypes. At the individual level, there are differences
study showed that general practitioners have very dif-
as well as overlaps and common characteristics
ferent attitudes and experiences about obesity man-
between the types 2 to 4.
agement. These can be classified into four (proto-)
The types formed could be used as a starting point
types that impact the willingness to provide care and
for future research to examine to what extent these
support as well as specific approaches and strategies
basic patterns of attitudes and positions on obesity
for obesity management and doctor–patient commu-
management exist in everyday practice among general
nication. In terms of therapeutic measures, this results
practitioners. In addition to broader quantitative sur-
in different perspectives and chances of success.
veys, work with prototypical case vignettes would be
conceivable. The use of focus groups could also help
to work out these basic patterns based on a con- Disclosure statement
trolled discussion. This can already be linked to a pre- The authors report no conflicts of interest. The authors alone
liminary study [23]. are responsible for the content and the writing of the paper.
34 J. WANGLER AND M. JANSKY

Data availability statement [15] Brotons C, Ciurana R, Pineiro R, et al., EUROPREV.

Dietary advice in clinical practice: the views of general
Research data is available upon request. practitioners in Europe. Am J Clin Nutr. 2003;77:
1048S–1051S.
[16] Huang J, Yu H, Marin E, et al. Physicians’ weight loss
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