The Obesity Paradigm and the Role of Health Services in Obesity Prevention: a systems view

Abstract

Aim The aim of this research was to examine the role of health services in obesity prevention and to examine how perspectives, relationships and system boundaries may enable or hinder the ability of health services to incorporate adult obesity prevention into practice. Background The increasing prevalence of obesity has a strong association with the growing rates of chronic disease in Australia. Health services have a clear role in the treatment of obesity, but the role of prevention is less well established. Further empirical evidence is required to understand how health services may play a more effective role in obesity prevention. Methods Qualitative research methodology was used to understand obesity prevention within a case study context. The use of grounded theory as a tool of analysis supported an approach which focussed on the perspectives of the participants and how these are influenced by the case-study setting, rather than to apply pre-existing theory. Results The review of the literature established health services should aim to screen for obesity and refer for intervention. This is not currently happening due to practical issues such as time and resourcing and because of health professionals’ views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. The use of grounded theory to analyse interviews with staff working at a macro, meso or micro level of one health system established that the way we frame obesity within health services as a matter of choice, and deliver services within a medical disease model, prevents health services from playing an effective role in the prevention of obesity. Conclusion The dichotomy of obesity as a disease overly simplifies a complex issue, resulting in a paradigm which frames obesity as a matter of individual responsibility and choice. Applying a systems approach to obesity switches the focus from the need for everybody to lose weight to focussing on the multitude of influences on someone’s behaviour and the range of ways to address change. At a healthcare delivery level, this could help support clinicians in working with individual patients and improve policy and service criteria development.