Personalizing obesity assessment and care planning in primary care: patient experience and outcomes in everyday life and health

Abstract

Obesity is a complex, chronic disease, frequently associated with multiple comorbidities. Its management is hampered by a lack of translation of evidence on chronicity and pathophysiology into clinical practice. Also, it is not well understood how to support effective provider-patient communication that adequately addresses patients' personal root causes and barriers and helps them feel capable to take action for their health. This study examined interpersonal processes during clinical consultations, their impacts, and outcomes with the aim to develop an approach to personalized obesity assessment and care planning. We used a qualitative, explorative design with 20 participants with obesity, sampling for maximum variation, to examine video-recorded consultations, patient interviews at three time points, provider interviews and patient journals. Analysis was grounded in a dialogic interactional perspective and found eight key processes that supported patients in making changes to improve health: compassion and listening; making sense of root causes and contextual factors in the patient's story; recognizing strengths; reframing misconceptions about obesity; focusing on whole-person health; action planning; fostering reflection and experimenting. Patient outcomes include activation, improved physical and psychological health. The proposed approach fosters emphatic care relationships and sensible care plans that support patients in making manageable changes to improve health.

Keywords: obesity management; patient-centred care; primary health care; qualitative research.

Figure 1

Patient reported impacts and outcomes of a personalized consultation. Five direct cognitive and emotional impacts of the consultation facilitated four interrelated areas of change in patients’ everyday life that include positive behaviour change, improvements in physical, mental and social health as well as the adoption of strategies that help maintain change.

Figure 2

Key processes of personalized obesity assessment and care planning. Patients experienced eight interpersonal processes as having positive impact on their ability to make everyday changes. Engendering compassion is a central process that creates the space for the other processes to occur successfully. White space indicates processes that are initiated and take place during the encounter; grey space indicates patients’ lifeworld.