Public Health and Public Policy
Overweight and Obesity: Knowledge, Attitudes,
and Practices of General Practitioners in
France
Aurélie Bocquier,*† Pierre Verger,*† Arnaud Basdevant,‡ Gérard Andreotti,§ Jean Baretge,§
Patrick Villani,†¶ and Alain Paraponaris*†储
Abstract
BOCQUIER, AURÉLIE, PIERRE VERGER, ARNAUD
BASDEVANT, GÉRARD ANDREOTTI, JEAN BARETGE,
PATRICK VILLANI, AND ALAIN PARAPONARIS.
Overweight and obesity: knowledge, attitudes, and practices of
general practitioners in France. Obes Res. 2005;13:787–795.
Objective: To describe the current knowledge, attitudes, and
practices of French general practitioners (GPs) in the field
of adult overweight and obesity management.
Research Methods and Procedures: A cross-sectional tele-
phone survey interviewed a sample of 600 GPs, represen-
tative of the private GPs in southeastern France. A four-part
questionnaire assessed personal and professional character-
istics, attitudes and opinions about overweight and obesity,
relevant knowledge and training, and practices (diagnostic
methods, clinical assessments, weight loss objectives, types
of counseling).
Results: Most GPs knew that weight problems are health-
threatening, and 79% agreed that managing these problems
is part of their role. Nevertheless, 58% did not feel they
perform this role effectively, and one-third did not find it
professionally gratifying. Approximately 30% had negative
attitudes toward overweight and obese patients; 57% were
pessimistic about patients’ ability to lose weight; 64% often
set weight loss objectives more demanding than guidelines
Received for review March 4, 2004.
Accepted in final form January 18, 2005.
The costs of publication of this article were defrayed, in part, by the payment of page
charges. This article must, therefore, be hereby marked “advertisement” in accordance with
18 U.S.C. Section 1734 solely to indicate this fact.
*Southeastern France Regional Center for Disease Control, Marseilles, France; †Inserm
Research Unit 379 ‘Epidemiology and social sciences applied to medical innovation’,
Marseilles, France; ‡Hotel Dieu Nutrition Department, University Paris 6, Paris, France;
§Southeastern France Regional Union of Private Practitioners, Marseilles, France; ¶Labo-
ratory of Therapeutics, Department of Medicine, University of the Mediterranean, Mar-
seilles, France; and 储Department of Economics, University of the Mediterranean, Marseilles,
France.
Address correspondence to Aurélie Bocquier, ORS PACA, 23 rue Stanislas Torrents, 13 006
Marseilles, France.
E-mail: bocquier@marseille.inserm.fr
Copyright © 2005 NAASO
call for; and neither food diaries nor nutritional education
were used systematically. GPs’ feelings of effectiveness and
attitudes toward obese patients were associated with some
professional (training) and personal (BMI, personal diet
experience) characteristics.
Discussion: GPs’ feelings of ineffectiveness may stem from
an underlying conflict between practitioners’ and patients’
representations of weight problems and the relationship
problems this causes. Inadequate practices and health care
system organization may also play a role.
Key words: obesity management, prevention, guidelines,
nutrition
Introduction
The pandemic of overweight and obesity in developed
and developing countries presents a challenge to public
health and requires medical intervention, modifications of
individual behavior, and environmental changes (1). Epide-
miological studies in France, Spain, and Italy have shown
this disease striking the Mediterranean area, where food
habits have long seemed to protect against cardiovascular
risks (2,3). General practitioners (GPs)1 have a significant
role to play in preventing and diagnosing weight problems
and in providing initial counseling (4,5). They are, after all,
the health professionals consulted most often (6), and most
patients believe that their GPs could—and wish they
would— help them to lose weight (7). Nonetheless, GPs do
not manage overweight and obesity satisfactorily, as they
themselves recognize (8 –11): they identify only about one-
half of their overweight or obese patients (12–14) and
advise only one-third of these patients to lose weight
(15–17).
1
Nonstandard abbreviations: GP, general practitioner; CME, continuing medical education.
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GPs’ Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 1. Demographic characteristics of the sample of respondents and of the population of private general
practitioners in Provence
General population of Sample of
GPs in Provence respondents
(n ⴝ 5435) (n ⴝ 600)
␹2
n Percentage n Percentage tests
Sex
Male 4140 76.2 452 75.3
Female 1295 23.8 148 24.7 p ⫽ 0.65
Age (years)
⬍43 1398 25.7 158 26.3
43 to 52 2889 53.2 305 50.8
⬎52 1148 21.1 137 22.8 p ⫽ 0.50
Size of practice area
(number of inhabitants)
⬍2000 357 6.6 52 8.7
2000 to 200,000 1334 24.5 150 25.0
⬎200,000 3744 68.9 398 66.3 p ⫽ 0.13

GPs’ attitudes toward and practices in the management of
weight problems have been studied in various English-
speaking countries (8,10,11,18), but we are aware of very
few published studies from Mediterranean countries (9). We
conducted a study of GPs in private practice in Provence
(southeastern France) to document their knowledge, atti-
tudes, and practices regarding adult overweight and obesity
management.
Research Methods and Procedures
Sample
In March 2002, we set up a panel of GPs in private
practice in Provence to evaluate their medical and prescrib-
ing practices over a 3-year period. Specialists, GPs with
exclusive particular practices (e.g., homeopathy, acupunc-
ture), and those planning to move outside the area or retire
were excluded. We stratified the sampling base according to
sex, age (⬍43, 43 to 52, and ⬎52 years old), and size of
practice area (⬍2000, 2000 to 200,000, and ⬎200,000
inhabitants) and randomly selected 1200 GPs from the
resulting strata to obtain a 600-GP sample representative of
the 5435 private GPs in Provence. Of these 1200 GPs, 1076
(89.7%) met the inclusion criteria, and 600 of 1076 (55.8%)
agreed to participate. Refusal rates were not significantly
different between strata.
From May to July 2003, we conducted telephone inter-
views of these GPs to document their attitudes about and
practices for overweight and obesity management: 580 of
600 (96.7%) participated, 12 of 600 (2.0%) withdrew, and 8
of 600 (1.3%) could not be contacted. We replaced these 20
GPs with new physicians randomly selected in correspond-
ing strata. The distribution of sex, age, and size of practice
area in our sample was similar to that of the regional GP
population (Table 1).
Questionnaire
To facilitate comparisons with previous studies, the
questionnaire was based on a review of the international
literature in overweight and obesity management in primary
care and on U.S. and French guidelines for identifying,
evaluating, and treating them (4,5). It was reviewed by a
group of experts (four nutritionists, one endocrinologist,
four physicians, and one sociologist) and pilot-tested with
17 GPs for length, clarity, and suitability. It included four
main parts.
Professional and Personal Characteristics. We assessed
the following characteristics: billing sector (in the con-
trolled billing sector, the fee per consultation is set by the
Health Insurance Administration; in the noncontrolled bill-
ing sector, GPs freely set their own fees according to market
pressure and patient income), solo/group practice, subscrip-
tion to medical journals, guidelines use, involvement in a
health network (coordinated group of several health profes-
sionals organized to improve health care in a specific med-
ical field), and postgraduate medical degrees. We also asked
about their height and weight (for calculating their BMI),
personal experience of dieting, behavior related to food
intake, physical activity, and tobacco consumption.

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GPs’ Attitudes and Practices about Overweight and Obesity, Bocquier et al.
Attitudes and Opinions about Overweight and Obesity.
Eleven items allowed us to examine GPs’ perception of
weight problems, involvement in their management, and
perception of their training, effectiveness, and professional
gratification in this field. Three items assessed their opin-
ions about overweight and obese patients on a four-point
Likert scale (from not at all to strongly) including: “do
overweight (obese) people tend to be lazier and more self-
indulgent than normal weight people?”; “are overweight
and obese people able to lose weight and maintain that
loss?” We included 17 items to assess GPs’ beliefs about
risk factors for and consequences of obesity and their views
of the importance of different outcomes as measures of
success in its treatment. We used a six-point Likert scale for
respondents to indicate the level of importance for each item
(1 ⫽ not important, 6 ⫽ extremely important).
Knowledge and Training in the Field of Overweight and
Obesity Management. GPs were asked 1) to estimate the
prevalence of overweight and obesity among French adults;
2) about health risks associated with obesity in adults (eight
risks, yes/no answers); 3) whether they were aware of the
guidelines for obesity management; 4) their main source of
relevant information [medical journals, continuing medical
education (CME), obesity management guidelines, com-
puter programs/Internet, experiences described by patients,
dietitians/endocrinologists, mass media]; and 5) whether
they had medical training about weight management and
whether they felt they needed more training in various
aspects (counseling about nutrition or physical activities,
psychotherapy, behavioral therapy, drug treatment, surgical
treatment).
Practices in the Management of Weight Problems. Par-
ticipants were asked about their practices at different stages
of weight management: diagnostic methods, clinical assess-
ments, standard weight loss objectives and strategies, coun-
seling about nutrition and exercise, follow-up, referral to
other health professionals, and perceived barriers to over-
weight and obesity care. Participants responded on a four-
point Likert scale (from never or rarely to always or almost
always).
Survey Procedure
We used a computer-assisted telephone interview system
to question participants. Each interview lasted ⬃30 minutes.
Data Analysis
Analysis began with simple frequency counts. We used
␹2 tests to examine differences between the sample and the
general population of GPs and to test differences in man-
agement for overweight and for obesity. We used the Fisher
statistic to examine the differences between mean scores of
various items (e.g., beliefs about causes of obesity). We
conducted simple and backward multiple logistic regression
analyses (entry threshold: p ⱕ 0.15; exit threshold: p ⬎
0.10) to study associations between GPs’ professional and
personal characteristics, their opinions about their effective-
ness in this field, and their attitudes toward obese people.
We used the Hosmer-Lemeshow goodness-of-fit test to
measure the fit of each model. Statistical analyses used
SPSS software (version 11.0; SPSS Inc., Chicago, IL).
Results
GPs’ Characteristics
Most GPs (82.8%) practiced in the controlled billing
sector, and 55.4% practiced in group practices. Only 44.8%
subscribed to medical journals, 69.7% consulted guidelines,
47.8% had postgraduate medical degrees, and 15.7% were
involved in a health network. The prevalence of overweight
among GPs [30%; 95% confidence interval (CI) ⫽ 26.3 to
33.7] was close to that of the French adult population
(29.4%; 95% CI ⫽ 28.9 to 29.9), but the prevalence of
obesity was lower: 3% (95% CI ⫽ 1.8 to 4.6) vs. 9.6% (95%
CI ⫽ 9.2 to 10.0) (19). Approximately one-third of GPs had
dieted (84% lost weight); 71.5% considered their eating
habits to be healthy; 76.9% reported exercising at least
weekly; 69.9% were currently monitoring their food intake
to lose or maintain weight; and 26% were current smokers.
GPs’ Attitudes Toward Overweight and Obesity
Most GPs regarded obesity as a disease and agreed that
their role includes weight problem management, but 57.5%
felt that they do not manage it effectively. Approximately
30% considered overweight and obese patients lazier and
more self-indulgent than normal weight people, and 57.2%
were rather pessimistic about these patients’ ability to lose
weight (Table 2).
The multiple logistic regression (Table 3) showed that
practice in the noncontrolled billing sector (p ⫽ 0.01), CME
training about weight problems (p ⬍ 0.01), awareness of
obesity management guidelines (p ⫽ 0.02), normal weight
(p ⫽ 0.05), and personal success in losing weight (p ⫽ 0.01)
were associated with a feeling of effectiveness in this field.
Negative attitudes toward obese patients were associated
with not subscribing to any medical journals (p ⫽ 0.03),
awareness of obesity management guidelines (p ⫽ 0.03),
and never having dieted themselves (p ⫽ 0.05; Table 3).
GPs rated food intake as a significantly more important
risk factor for obesity than stress, hormonal problems, or
unemployment. They also rated the medical consequences
of obesity as more important than its psychological and
social consequences (Table 4).
GPs’ Knowledge and Training in the Field of Weight
Control
Most GPs (51.2%) underestimated the prevalence of
overweight in the French adult population, whereas one-half
overestimated the prevalence of obesity. Nearly all recog-
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GPs’ Attitudes and Practices about Overweight and Obesity, Bocquier et al.

Table 2. GPs’ attitudes towards overweight and obesity (Provence, 2003)

Responses (%)
Strongly Rather Rather Strongly
Statements n disagree disagree agree agree
Obesity is a disease 595 2.5 7.2 33.4 56.8
Normal weight is important for health 599 0.7 0.2 16.9 82.3
For overweight and obese patients even small weight
loss can produce health benefits 596 0.0 0.8 21.5 77.7
Most overweight patients should be treated for
weight loss 598 0.8 5.9 47.5 45.8
Only obese patients should be treated for weight loss 595 40.2 39.8 14.6 5.4
Obesity management is necessary in the long term 598 0.2 0.3 15.9 83.6
GPs’ role is to refer overweight and obese patients
to other professionals rather than attempt to treat
them themselves 594 31.0 48.0 17.5 3.5
GPs should be models and maintain normal weight 595 7.7 8.7 53.1 30.4
I feel well prepared to manage overweight and obese
patients 596 5.9 26.5 44.6 23.0
Treating overweight and obese patients is
professionally gratifying 595 7.6 23.9 48.4 20.2
Obese people are lazier and more self-indulgent than
normal weight people 597 27.3 41.9 26.1 4.7
Overweight people are lazier and more self-indulgent
than normal weight people 594 25.9 45.5 24.9 3.7
Only a small percentage of overweight and obese
people can lose weight and maintain this loss 597 11.9 30.8 48.2 9.0

nized most health consequences of obesity (premature mor-
tality, type II diabetes, sleep apnea, hypertension, increased
surgical risks, phlebitis), but 53% were unaware of the risks
of infertility, and 45.5% were unaware of the risks of some
cancers. Only 6.7% were aware of the guidelines for obesity
management. One-half reported that their main source of
information in this field was medical journals, 25.2% was
CME, and 10.4% was experience described by patients. Just
over one-half of the GPs (54.2%) had taken a CME class in
weight management, and 80% acknowledged they needed
more training, especially about nutrition counseling and
behavioral therapy.
GPs’ Practices
Most GPs (88.5%) often or always used BMI as a diag-
nostic method, whereas only 41% often or always measured
the waist (Table 5).
More than 90% of the participants often or always assessed
individual risk factors, physical activity, dietary habits, pa-
tients’ expectations and motivation, patients’ psychological
state, existence of food behavioral problems, and weight his-
tory; a lower but still high proportion (70% to 90%) often or
always assessed respiratory problems, venous and lym-
phatic conditions, joint diseases, calory intake, energy ex-
penditure, and social status; 60% to 70% often or always
checked for hepatomegaly or steatosis, sleep disorders, and
pain; and 30% to 40% often or always assessed skin con-
dition and looked for cancerous breast nodules.
One-half the sample (50.8%) set a loss of 5% to 15% of
initial weight as the objective for overweight patients. To
reach this goal, 23.2% often or always prescribed drug
treatment, 31.6% recommended psychotherapy, 14.8% rec-
ommended a behavioral therapy, and almost one-half in-
cluded a spouse or a close relative in the treatment. Too
stringent treatment objectives for obese patients were set
by 64.3% of GPs (weight loss to normal BMI or ⬎15%;
Table 6).
Nearly all participants (90% to 99%) gave traditional
nutritional advice (Table 5). Only 35% often or always
counseled avoiding specific foods, and 22% suggested very

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Table 3. Determinants of GPs’ feelings of effectiveness and attitudes towards obese people (multiple logistic
regression with sex and age forced; Provence, 2003)
Model 2: thinks obese people
Model 1: feels effective in tend to be lazier and more self-
management of weight indulgent than normal weight
problems (n ⴝ 578) people (n ⴝ 591)
OR 95% CI p (Wald) OR 95% CI p (Wald)
Billing sector 0.01
Controlled billing sector 1
Noncontrolled billing sector 1.94 1.22 to 3.08
Medical journal subscription 0.03
Yes 0.67 0.46 to 0.96
No 1
Has taken a CME class about management of
weight problems 0.00
Yes 1.66 1.17 to 2.36
No 1
Knows guidelines for obesity management 0.02 0.03
Yes 2.35 1.13 to 4.86 2.15 1.10 to 4.20
No 1 1
Current BMI (kg/m²) 0.05
Underweight or normal range (⬍25) 1
Overweight (25 to 29.9) 0.59 0.39 to 0.90
Obese (ⱖ30) 0.71 0.24 to 2.13
Has ever been on a diet 0.01 0.05
No 1 1
Yes and it succeeded 1.91 1.25 to 2.91 0.64 0.41 to 0.98
Yes but it failed 0.94 0.38 to 2.32 0.55 0.16 to 1.17
Hosmer-Lemeshow test p ⫽ 0.31 p ⫽ 0.95

Variables statistically not significant in univariate analysis: 1) any model: sex, age, solo/group practice, guidelines use, belongs to a health
network, postgraduate medical degrees, is currently monitoring his food intake, tobacco status; 2) model 1: medical journal subscription,
reports regular physical activity; 3) model 2: billing sector, CME class, current BMI, reports a healthy diet.
Variables statistically significant in the univariate but not the multivariate analysis: 1) any model: size of practice area; 2) model 1: reports
a healthy diet; 3) model 2: reports regular physical activity.
OR, odds ratio.

low-calorie diets; 36.2% never, rarely, or sometimes offered
nutritional education, and 60.7% never, rarely, or some-
times recommended that patients use food diaries.
Nearly all of the GPs saw these patients at least monthly,
and 40% often or always proposed a telephone follow-up
between consultations. Less than one-third referred patients
to other professionals, and only 31% often or always re-
ferred their overweight or obese patients to a dietitian.
The most common problems experienced by GPs in treat-
ing overweight or obese patients were lack of patient mo-
tivation (often or always encountered by 60.1% of partici-
pants), lack of support from patients’ relatives (57.1%), lack of
time (53.3%), nonreimbursement of consultations with
dietitians (51.3%), and patient’s nutritional knowledge
(39.2%).
Discussion
We found that most GPs believed their role in overweight
and obesity management is important but did not feel that
they performed it effectively. This observation is consistent
with results of other studies of GPs (8,9,11) and also,

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GPs’ Attitudes and Practices about Overweight and Obesity, Bocquier et al.

factors or stress and unemployment; behavioral factors are

Table 4. GPs’ beliefs about obesity risk factors and generally considered more controllable by the individual
consequences and their perception of success in the than unemployment, for example (18). This model clashes
management of weight problems (in decreasing rank with patients’ views: they attribute more importance to risk
order; Provence, 2003) factors over which they have little or no control (21).
Mean* SD Moreover, one-third of the GPs had stereotypical and neg-
ative attitudes toward overweight and obese patients. Al-
Risk factors† though these attitudes seem less prevalent among health
Eats too much fat 5.2 0.93 professionals than they were 30 years ago (22,23), they are
Eats too much 5.1 1.02 still held by 30% of GPs, internists, and cardiologists and by
Eats too much sugar 4.9 1.01 a lower fraction of endocrinologists (9 –11,20), and their
Insufficient physical activity 4.7 1.08 prevalence tends to increase with patient BMI (18,24).
Genetic factors 4.5 1.25 Studies suggest that this basic disagreement may be asso-
Repeated dieting 4.2 1.26 ciated with poorer patient outcomes (25,26) and that pa-
tients’ negative responses to these attitudes creates a vicious
Stress. anxiety, and depression 4.1 1.07
circle that reinforces the doctors’ attitudes (24). Support for
Hormonal problems 3.7 1.28
this observation comes from the less negative attitudes and
Low income, unemployment 3.3 1.19 greater feelings of effectiveness of GPs who have success-
Consequences‡ fully lost weight themselves: personal experience may re-
Medical problems 4.9 1.11 duce the discrepancies between GPs’ and patients’ repre-
Psychological problems 4.3 1.04 sentations of the disease.
Social problems 3.8 1.09 Because negative attitudes toward the obese and feelings
Success indicators in weight problems of effectiveness were not associated with age, it is unlikely
management§ that either initial training or experience affected them sub-
Adoption of healthier diet and stantially. Our results suggest, however, that appropriate
exercise habits 5.3 0.75 information may improve GPs’ attitudes toward and opin-
Weight loss to the normal BMI ions about obese patients. GPs who subscribed to medical
range 5.1 0.96 journals were less likely to think that obese people tend to
be lazier than normal weight people, perhaps because they
Improvement of body image and self
were more aware that environmental obesity risk factors,
confidence 5.0 0.89
not controllable by patients, exist. Although guidelines
Even small weight loss but long- stress that GPs’ attitudes may affect the quality of their
lasting 4.7 0.94 patient treatment (4,27), awareness of the guidelines was,
Improvement in clinical indicators 4.6 1.07 surprisingly, associated with more negative attitudes, per-
haps because awareness of the guidelines does not neces-
* Mean of GPs’ responses on a six-point Likert scale (from 1 ⫽ sarily entail their use.
not important to 6 ⫽ very important). One striking finding was that the GPs substantially un-
† Pairwise comparisons of means: p ⬍ 0.05 except “eats too much derestimated the prevalence of overweight and overesti-
fat vs. eats too much” (p ⫽ 0.38) and “repeated dieting vs. stress mated that of obesity. This suggests that they may rely
anxiety and depression” (p ⫽ 0.18); ‡ Pairwise comparisons of mainly on a therapeutic rather than preventive approach to
means: p ⬍ 0.05; § Pairwise comparisons of means: p ⬍ 0.05 weight problems, an attitude that may delay management of
except “even small weight loss but long-lasting vs. improvement in
weight problems. A U.S. study showed that health care
clinical indicators” (p ⫽ 0.12).
providers advise relatively few overweight patients to lose
or even to not gain weight (16), although maintaining cur-
rent weight is known to be easier than losing weight (4).
interestingly, of endocrinologists and internists (20). Sev- Some more specific practices may also impede satisfac-
eral obstacles may explain this apparent contradiction. tory outcomes: ⬎60% of GPs set stricter weight loss objec-
Physicians and patients have different perceptive and tives for obese patients than recommended (4,5). This find-
attitudinal models of weight problems, and one major ob- ing seems to be new: previously published results showed
stacle may be the problem this creates in their relationship. that GPs have reasonable expectations about weight loss
Our results suggest that GPs’ perceptions of overweight and (8,28). This result may be consequential because it may
obesity are shaped by a model that blames the victim (21): reinforce unrealistic and unachievable weight loss goals that
they perceive behavioral factors (food habits and physical may be a significant source of failure for patients (29 –31).
activity) as greater risk factors for obesity than genetic One of the things patients want most from a primary care

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Table 5. GPs’ practices in the field of adult overweight and obesity management (Provence, 2003)
Responses (%)
Never Always or
Practices n or rarely Sometimes Often almost always
Diagnosis methods
Weight without reference to height 600 77.0 7.5 7.8 7.7
BMI 600 6.3 5.2 16.0 72.5
Waist/hips ratio 599 44.2 20.9 19.2 15.7
Waist measurement 599 38.7 20.2 23.5 17.5
Comparison with ideal weight (according to
Lorentz formula) (39) 598 46.8 19.7 18.4 15.1
Appearance 598 21.4 18.6 29.9 30.1
Weight management advice and tools
Eat less during meals 595 10.4 13.9 25.0 50.6
Eat less fat 598 0.5 1.8 17.9 79.8
Don’t eat between meals 597 6.0 3.0 16.1 74.9
Eat less sugar 597 0.7 4.5 21.4 73.4
Eat more fruits and vegetables 597 0.7 3.9 17.6 77.9
Consume fewer caloric drinks 598 0.0 0.3 8.2 91.5
Definitely avoid specific foods 599 53.4 11.2 14.4 21.0
Follow personalized low-calorie diet (1200 to
2200 kcal/day) 597 11.6 14.6 37.7 36.2
Follow very-low-calorie diet (⬍1200 kcal/day) 598 55.0 22.6 14.7 7.7
Follow commercial diet 598 53.8 33.8 8.7 3.7
Exercise (sports) 598 3.8 9.4 30.1 56.7
Do more exercise in everyday life (e.g.,
walking, gardening) 587 2.0 2.7 18.6 76.7
Leaflets on healthy behavior 597 12.6 21.4 31.0 35.0
Food diary 597 37.4 23.3 20.4 18.9
Nutritional education 598 17.6 18.6 29.9 33.9

physician is help in setting realistic weight goals (7). GPs
should also help them to improve their body image and
self-esteem and make them aware that a small weight loss
can produce important medical benefits (30,31).
Additionally, participants’ nutritional counseling prac-
tices did not meet guidelines for successful dietary therapy:
36.2% rarely provided nutritional education, and 60.7%
rarely suggested use of a food diary (4,27). Thus, nutritional
management often seems limited to one-shot advice and
neglects tools that could help induce long-term behavior
modifications.
Beyond these barriers, other problems related to the
health care system must be considered, including time con-
straints, modes of reimbursement, and training content.
Most GPs in this study, as in others (32,33), reported
frequently lacking time, a problem known to be a significant
barrier to preventive care in general practice (34,35). Ex-
planations for patients, discussion of treatment and preven-
tion, and health education require longer consultations. We
found GPs in the “fixed-fee” billing sector were less likely
to feel effective in overweight and obesity management.
The type of remuneration influences length of consultation
(36); therefore, GPs in this sector may have shorter consul-
tations than the others.
GPs who had taken a CME course and were aware of
weight control guidelines felt more effective, probably be-
cause this training increased their self-confidence and con-
vinced them that success is possible. The need for better
training in the field of weight control was recognized by
80% of the GPs in our panel and has been pointed out by
internists, endocrinologists (20), and gynecologists (37).
Analyses of potential associations between GPs’ age and
various practices and knowledge did not provide convincing
evidence that young GPs, who should have received better

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GPs’ Attitudes and Practices about Overweight and Obesity, Bocquier et al.

less, like specialists, including endocrinologists and inter-

Table 6. Objectives and strategies in the field of nists, most believed their treatment was of limited effec-
overweight and obesity management (Provence, 2003) tiveness, and one-third reported dissatisfaction with it.
Responses (%) Obstacles to satisfactory management seem to include GPs’
attitudes and opinions and to some extent inadequate prac-
Overweight Obesity tices. In particular, we found, in a relatively new observa-
management management tion, that GPs set weight loss objectives for obesity man-
agement that were frequently too stringent.
Usual weight loss objective A current reform of the French health care system will
No weight gain 2.2 1.4 give GPs a central role in health education and prevention.
Weight loss of 5% to 15% Their attitudes and knowledge may thus determine whether
of initial weight and its they can maintain this role and perform it effectively. How-
maintenance 50.8 34.3* ever, organizational aspects, especially remuneration for the
Weight loss of ⬎15% of time needed to implement prevention and education, must
initial weight and its also be considered: for example, the institution of incentive
maintenance 14.0 45.0* fees for consultations for preventive and education purposes
Weight loss to the normal might be useful. Assessment of these measures would then
BMI range 33.0 19.3* be necessary (38). Facilitating work cooperation between
GPs and medical auxiliaries (such as dietician) might also
Management strategies (% of
improve prevention and management of weight problems.
often or always
responses)
Acknowledgments
Drug treatment 23.2 40.5*
This work received technical and financial support from
Psychotherapy 31.6 48.8* the Southeastern France Regional Union of Private Practi-
Behavioral therapy 14.8 24.2* tioners (URML PACA) through the Southeastern France
Inclusion of a spouse or a Regional Union of Health Insurance (URCAM PACA)
close relative in the Funds for Quality in Ambulatory Health Care (FAQSV).
management 48.9 60.2* We thank Drs. C. Colette, C. Fischler, M. L. Frelut, P.
Garandeau, M. Gerber, J. C. Gourheux, Jouret, P. Y. Lus-
* p ⬍ 0.001. sault, M. Pellae, M. Rousseaux-Romon, M. Tauber, and H.
Thibault for invaluable help and advice and Jo Ann Cahn
for editorial assistance.

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older colleagues (results not shown).
Limitations
These self-reported data may not exactly reflect the real-
ity of respondents’ attitudes and practices. GPs may be
reluctant to declare that obese patients are lazier than nor-
mal weight people, that they do not feel that they provide
effective treatment, or that they lack confidence in their
ability to counsel patients in this area. They may also have
overreported practices recommended by the guidelines,
such as BMI use for diagnosing weight problems. More-
over, because this study is cross-sectional, we cannot draw
causal inferences from the associations observed.
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nostic practices require improvement, most of their reported
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