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General Practice Care of Overweight and Obese Patients: an Analysis from a Health Psychology Perspective

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General Practice Care of Overweight and Obese Patients: an Analysis from a Health Psychology Perspective Fachbereich Erziehungswissenschaft und Psychologie der Freien Universität Berlin GENERAL PRACTICE CARE OF OVERWEIGHT AND OBESE PATIENTS: AN ANALYSIS FROM A HEALTH PSYCHOLOGY PERSPECTIVE Dissertation zur Erlangung des akademischen Grades Doktorin der Philosophie (Dr. phil.) vorgelegt von Dipl.-Psych. Ulrike Sonntag 2011 Erstgutachten: Prof. Dr. Babette Renneberg Zweitgutachten: Prof. Dr. Vittoria Braun Disputation am 25.11.2011 DANKSAGUNG Ich danke Frau Prof. Dr. Babette Renneberg für die Betreuung dieser Dissertation. Durch zahlreiche Anregungen und Diskussionen im Kolloquium hat sie mich immer wieder zum Nachdenken angeregt und meiner Arbeit wichtige Impulse verliehen. Herzlich möchte ich Frau Prof. Dr. Vittoria Braun für Ihre jahrelange Unterstützung danken. Ihr hohes Engagement für die Allgemeinmedizin hat mich inspiriert und für dieses Promotionsvorhaben motiviert. Ich danke ihr für die großen Freiheiten bei der Bearbeitung dieses Themas, das gleichbleibende Interesse und ihr stetes Vertrauen in mich. Die Zusammenarbeit in diesem Projekt mit meinem Kollegen Dr. Christoph Heintze MPH war stets angenehm und bereichernd. Unsere Diskussionen über die Chancen und Herausforderungen der Versorgung übergewichtiger und adipöser Patienten haben maßgeblich zum Gelingen dieser Arbeit beigetragen. Ebenso danke ich den Mitarbeitern des Instituts für Allgemeinmedizin der Charité, insbesondere Frauke Dohle und Anke Krause, für ihre freundliche Unterstützung. Mein Dank gebührt den Studierenden, v.a. Julia Wiesner, Lynn von Hagen und Anna Brinck, die an diesem Projekt mitgewirkt haben. Insbesondere ihr Engagement bei der Datenerhebung und -aufbereitung hat mir sehr geholfen. Ohne die Patienten und Ärzte die mir bereitwillig Einblicke in ihre Interaktionen lieferten, wäre diese Arbeit nicht möglich gewesen. Ich weiß, dass dieser Schritt nicht immer leicht war und danke sehr für das Vertrauen. Ich danke meiner Familie und meinen Freunden für anregende Diskussionen und die Geduld mit mir und dieser Dissertation. CONTENT 1 GENERAL INTRODUCTION .............................................................................................. 1 1.1 OVERWEIGHT AND OBESITY .................................................................................. 1 1.1.1 DEFINITION AND EPIDEMIOLOGY ................................................................................... 1 1.1.2 CAUSES OF OVERWEIGHT AND OBESITY ........................................................................... 3 1.1.3 CONSEQUENCES OF OVERWEIGHT AND OBESITY ................................................................ 4 1.1.4 TREATMENT OF OVERWEIGHT AND OBESITY ..................................................................... 4 1.2 OVERWEIGHT AND OBESITY IN PRIMARY MEDICAL CARE ............................................... 8 1.2.1 THE GP’S ROLE IN OVERWEIGHT AND OBESITY TREATMENT ................................................. 8 1.2.2 THE CHECK-UP 35 .................................................................................................... 10 1.3 HEALTH PSYCHOLOGY, OVERWEIGHT AND OBESITY ..................................................... 12 1.3.1 MODELS OF HEALTH BEHAVIOR ................................................................................... 13 1.3.2 COGNITIONS – ATTRIBUTIONS AND LOCUS OF CONTROL .................................................. 16 1.3.3 INTERVENTIONS ....................................................................................................... 18 1.4 AIMS OF THE STUDIES ........................................................................................ 20 2 STUDIES 1 – 5.......................................................................................................... 21 2.1 STUDY 1: PERCEPTION OF STRESS AND QUALITY OF LIFE IN OVERWEIGHT AND OBESE PEOPLE – IMPLICATIONS FOR PREVENTIVE CONSULTANCIES IN PRIMARY CARE.................... 21 2.1.1 SUMMARY .............................................................................................................. 21 2.1.2 BACKGROUND ......................................................................................................... 22 2.1.3 MATERIAL AND METHODS .......................................................................................... 24 2.1.4 RESULTS ................................................................................................................. 26 2.1.5 DISCUSSION ............................................................................................................ 29 REFERENCES ........................................................................................................................ 33 Content I 2.2 STUDY 2: LOCUS OF CONTROL, SELF-EFFICACY AND ATTRIBUTION TENDENCIES IN OBESE PATIENTS – IMPLICATIONS FOR PRIMARY CARE CONSULTATIONS ........................... 37 2.2.1 SUMMARY .............................................................................................................. 37 2.2.2 BACKGROUND ......................................................................................................... 38 2.2.3 MATERIAL AND METHODS ......................................................................................... 40 2.2.4 RESULTS ................................................................................................................. 42 2.2.5 DISCUSSION ............................................................................................................ 45 REFERENCES ........................................................................................................................ 49 2.3 STUDY 3: COUNSELING OVERWEIGHT PATIENTS: ANALYSIS OF PREVENTIVE ENCOUNTERS IN PRIMARY CARE ............................................................................ 52 2.3.1 ABSTRACT ............................................................................................................... 52 2.3.2 INTRODUCTION ........................................................................................................ 53 2.3.3 METHODS ............................................................................................................... 55 2.3.4 RESULTS ................................................................................................................. 57 2.3.5 DISCUSSION ............................................................................................................ 60 REFERENCES ........................................................................................................................ 64 2.4 STUDY 4: OBESITY COUNSELING IN PRIMARY CARE – MOTIVATIONAL INTERVIEWING AND SHARED DECISION MAKING .......................................................................... 68 2.4.1 ABSTRACT ............................................................................................................... 68 2.4.2 INTRODUCTION ........................................................................................................ 69 2.4.3 METHODS ............................................................................................................... 71 2.4.4 RESULTS ................................................................................................................. 72 2.4.5 DISCUSSION AND CONCLUSION ................................................................................... 75 REFERENCES ........................................................................................................................ 79 2.5 STUDY 5: GPS’ ATTITUDES, OBJECTIVES AND BARRIERS IN COUNSELLING FOR OBESITY – A QUALITATIVE STUDY ......................................................................... 82 2.5.1 ABSTRACT ............................................................................................................... 82 2.5.2 BACKGROUND ......................................................................................................... 83 2.5.3 METHODS ............................................................................................................... 84 2.5.4 RESULTS ................................................................................................................. 85 2.5.5 DISCUSSION ............................................................................................................ 88 Content II REFERENCES ........................................................................................................................ 91 3 GENERAL DISCUSSION ................................................................................................ 93 3.1 SYNTHESIS OF RESULTS ...................................................................................... 93 3.2 GPS' ADHERENCE TO GUIDELINES ......................................................................... 95 3.3 TREATMENT IMPLICATIONS ................................................................................. 97 3.3.1 INCORPORATION OF PSYCHOMETRICAL PATIENT CHARACTERISTICS INTO COUNSELING ............. 97 3.3.2 SHARED DECISION MAKING ........................................................................................ 99 3.3.3 MOTIVATIONAL INTERVIEWING ................................................................................. 100 3.3.4 THE 5A CONCEPT ................................................................................................... 101 3.3.5 IMPLICATIONS OF MODELS OF HEALTH BEHAVIOR ......................................................... 104 3.3.6 USE OF NEW MEDIA FOR OVERWEIGHT AND OBESITY
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