Knowledge of primary health-care centers physician's about obesity in adult in Baghdad/Alkark

Noor Mohammed Jawad Hwaidi; Hanady Mohammad Alhilli; Ali Awad Zaidan

doi:10.4103/IRJCM.IRJCM_6_21

ORIGINAL ARTICLE

Year : 2020 | Volume : 33 | Issue : 2 | Page : 74-78

Knowledge of primary health-care centers physician's about obesity in adult in Baghdad/Alkark

Noor Mohammed Jawad Hwaidi, Hanady Mohammad Alhilli, Ali Awad Zaidan
Al-Karkh Health Directrate, Iraqi MoH, Baghdad, Iraq

Date of Submission	02-Oct-2020
Date of Decision	30-Nov-2020
Date of Acceptance	20-Dec-2020
Date of Web Publication	6-Jul-2023

Correspondence Address:
Dr. Hanady Mohammad Alhilli
Baghdad City/Al-Karkh Health Directrate, Iraqi MoH, Baghdad
Iraq

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IRJCM.IRJCM_6_21

Abstract

Introduction: Primary health care is still underutilized for obesity counseling and adequate training may increase physician involvement in overweight prevention and treatment, exploring physicians' awareness is important for the design of special training programs to manage deficiencies in knowledge and practices. Objectives: The objective is to assess the knowledge of primary health care centers' physicians about obesity. Subjects and Methods: A cross-sectional descriptive study was carried out for 4 months: A Convenient sample of 129 primary health-care physicians were included, assessment of knowledge consisted of 15 questions, and their answers may be one of 3 (”Yes,” “No” or “I don't know”) according to knowledge of participants. For knowledge assessment, if a participant had 7 or less correct answers, it was considered poor knowledge, and if more than 8 correct answers out of the 15 questions then it considered adequate knowledge. Results: From the 129 study sample, only 11 had training in obesity courses. There were 82.9% of participants identify obesity as a disease, and 75.2% agreed that primary health care physicians playing a dominant role in assessing and managing obesity. In the current study, 98.4% of participants answered correctly about obesity relation to chronic conditions, 40.3% of physicians had incorrect information about low social class can predispose to obesity. In this study, only 50.4% of physicians used body mass index for obesity classification in all health conditions. Conclusions: Most of the physicians who were involved in the study had an adequate knowledge about obesity (92.2%).

Keywords: Body mass index, knowledge of physician, obesity

How to cite this article:
Hwaidi NM, Alhilli HM, Zaidan AA. Knowledge of primary health-care centers physician's about obesity in adult in Baghdad/Alkark. IRAQI J COMMUNITY MED 2020;33:74-8

How to cite this URL:
Hwaidi NM, Alhilli HM, Zaidan AA. Knowledge of primary health-care centers physician's about obesity in adult in Baghdad/Alkark. IRAQI J COMMUNITY MED [serial online] 2020 [cited 2023 Oct 2];33:74-8. Available from: http://www.journalijcm.org/text.asp?2020/33/2/74/380715

Introduction

Obesity can be defined as a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems, overweight: Technically refer to an excess of body weight.^[1]

Primary health care is still underutilized for obesity counseling and its capacity is usually restrained by a number of limitations, such as short consultation time, patients' low motivation and noncompliance, inadequate teaching materials, low level of physicians' confidence, and a shortage of dietitians.^[2],[3]

Adequate training may increase physician involvement in overweight prevention and treatment, exploring physicians' awareness is important for the design of special training programs to manage deficiencies in knowledge and practices.^[4],[5]

Aim of the study

This study aims to assess the knowledge of primary health care centers physicians (PHCCPs) about obesity.

Subjects and Methods

Study design and duration

A cross-sectional descriptive study was carried out for 4 months, from First of February to the end of May 2017, at a primary health-care centers in Baghdad city/Al-Karkh, for 2 days per week.

Data were collected from 16 primary health-care centers in Baghdad City\Al Karkh and were chosen conveniently include:- (AlZahraa, AlMansuor, AlSalam AlTadriby, Al ADel, Al Dakilia, Al Yarmook, AL Jawadeen, Al Hurea, Al Salam Al Sakaani, AL Shaheed Saif Zaki, Al Iraq Al Jadeed, Al Kedraa, Al Washash, Hateen, Al Sabeeat, and Al Jammea).

Study subjects

Convenient sample of 129 PHCCPs, who were willing to participate in this study, and were working at the primary health-care center at time of data collection, who included physicians from both sex. Privacy and confidentiality were considered after verbal consent. Participants were given the right to withdraw from the study at any time.

Tool for data collection

Data were collected through a questionnaire which were derived from the European guideline recommendations on obesity,^[6] assessment of knowledge consisted of (15) questions, and their answers may be one of 3 (”Yes,” “No,” or “I don't know”) according to knowledge of participants.

Statistical analysis

The data of physicians were analyzed by the application of Microsoft excel program and Statistical Package for Social Sciences (SPSS) version 23 international software for statistical analysis, USA. For knowledge assessment, if a participant had 7 or less correct answers it was considered poor knowledge, and if more than 8 correct answers out of the 15 questions then it was considered adequate knowledge.

Results

A total of 150 PHCCPs were included in this study with mean age of 43.5 ± 8.6 years; 35.3% of them were <40 years' age, 34.7% of them were in the age group of 40–49 years, 28% of them were in the age group of 50–59 years, and 2% of them were more than an equal 60 years of age. Females were more than males with female: male ratio as 2.6:1.

The highest qualifications of participants were distributed as followings: 62.3% bachelors, 30% board, 6% diploma, and 0.7% master. Mean a postgraduation year was 18 ± 8.4 years, 44% more and equal 20 years, 36.7% 10–19 years, and 19.3% of them have experience <10 years.

Only 11 PHCCPs were included in obesity management training; two physicians in nutrition training, two physicians in obesity training, two physicians in obesity and nutrition training course, etc. All these findings are shown in [Table 1].

Table 1: Distribution of participants according to training in obesity courses

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The correct answers for Q1: “is obesity a disease?,” were 107 (82.9%) and the remaining 22 (17.1%) participants answered incorrectly or did not know the right answer, For Q2: ”Waist circumference >40 inch (102 cm) in men and 35 inch (88 cm) in women indicate increase risk of obesity comorbidities,” 84 (65.1%) participants answered correctly, while 45 (34.9%) did not. For Q3: “Obesity is defined as body mass index (BMI) is equal or more than 30 kg/m²,” the correct answers were 114 (88.4%) and only 15 (11.6%) did not answer correctly. Regarding Q4: “Is obesity considered a leading cause of preventable death in developed countries?” Less than half of the participants 63 (48.8%) knew the correct answer. For Q5: “Are PHC physicians playing a dominant role in assessing and managing obesity?,” the correct answers were 97 (75.2%) and the incorrect and unknown were 32 (24.8%). All these findings are shown in [Table 2].

Table 2: Knowledge of participants regarding obesity Variable (Question 1-5)

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Regarding Q6: Is weight reduction indicated when BMI <30 even in the absence of cardio vascular risk factors?,” only 24 (18.6%) knew the right answer, and the majority 105 (81.4%) answered incorrectly. For Q7: “Is obesity risk factor for chronic disease?,” almost all participants answered correctly 127 (98.4%), which was similar to answers for Q8: “Are genetic predispose obesity?,” as 120 (93.0%) had right answers, also Q9: “Are hormonal abnormalities predispose obesity?,” showed a 128 (99.2%) correct answers. For Q10: “Is obesity has relation to psychological status?,” 124 (96.1%) of participants answered correctly. All these findings are shown in [Table 3].

Table 3: Knowledge of participants regarding obesity Variable (Question 6-10)

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Regarding Q11: “Is low socioeconomic class can predispose to obesity?,” the correct answers were 77 (59.7%). For Q12: “Is diet for weight loss should be high in carbohydrate and low fat?,” 97 answered correctly while 32 had wrong or did not know the answer. Regarding Q13: “Did you think that 5% to 15% weight loss can significantly reduce the complication associated with obesity?,” 73 (56.6%) answered correctly. Regarding Q14: “Do you belief that PHC physicians must be model and maintain normal weight?,” most participant had correct answers forming 112 (86.8%). For Q15: “Is BMI measurement are accurate for obesity classification in all health status?,” approximately half of the participants answered correctly 65 (50.4%). All these findings are shown in [Table 4].

Table 4: Knowledge of participants regarding obesity Variable (Question 11-15)

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Participants with poor knowledge regarding obesity were 10 (7.8%), while the remaining 119 (92.2%) participants showed adequate knowledge with varying number of correct answers as shown in [Table 5].

Table 5: Number of correct answers corresponding to participants

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Discussion

This study showed that 82.7% of participants had answered correctly according to that obesity one of noncommunicable disease with worldwide distribution, this result was similar to Al-Ghawi and Uauy in Bahrain,^[4] Al-Shammari in Saudi Arabia^[7] and with Sack et al., in the USA^[8] this meant that physician were aware of the impact of obesity as a noncommunicable disease, but their feeling that physicians had low effectiveness toward may be due to low level of interest in management or their perception that impact on patients was low.^[9],[10]

The current study showed that 65.1% of physicians had answered correctly about waist circumference in male and female, this agreed with Sebiany, in Saudi Arabia,^[11] it seemed low percentage, as it is easier to measure waist sometimes rather than calculating BMI, so this impaired a problem because not knowing ideal waist circumference will hinder identification of obese or overweight subjects.

Most of the physicians in this study had a correct answer about obesity definition (88.4%), and this goes with Sebiany, in Saudi Arabia,^[11] Sack, et al.,^[8] Park et al. in 2005 in Korea,^[12] all physicians must know correct obesity definition to be able to diagnose and manage this disease.

In this study, nearly two-third of physicians (75.2%) had answered correctly about their role in assessing and managing obesity, this agreed with Al-Ghawi and Uauy in Bahrain,^[4] as primary health-care physicians are in the front line in combating and preventing the disease, so the first encounter of an obese patients is usually them, and they must have all the solutions to this problem.^[7]

In the current study, 98.4% of participants answered correctly about obesity relation to chronic conditions and this was similar to participates in Sebiany,^[11] Foster and Wadden^[9] and Sack et al.^[8] Moreover, primary health-care physicians should not only be able to identify obesity but play a critical role in treating this endemic disease.^[13],[14]

Obese patients could have predisposing factors for example (genetic, hormonal, and psychological), so physicians in this study had good knowledge 93%, 99.2%, and 96.1% respectively and this agreed with Al-Shammari^[7] and Sack, et al.^[8]

Low social class can predispose to obesity, but (40.3%) of physicians had incorrect information, this agree with Sebiany,^[11] Burkert et al.^[15] showed that a low socioeconomic state has a significant negative impact on obese individuals' health.

The current study showed that (75.2%) of physicians believed that food for weight reduction must be low-fat and low-carbohydrate, this agreed with Foster and Wadden,^[9] because such food can increase insulin resistance, cardiovascular disease, and other problems.

This study showed that (56.6%) of participants knew that decreasing weight by 5%–15%, reduced complications and this agreed with, it was lower compared to the results shown by Foster and Wadden^[9] who showed that (75%) knew that point, also lower than the results of Sack et al.,^[8] as it was (93.9%), if physicians are aware of the fact that mild weight reduction is beneficial, they tend to use less aggressive treatment options, like medication or bariatric surgery, encouraging the patients and put more confidence in their ability to change their life style should be the first option.^[16],[17]

The present study showed that 86.8% of physicians believed that they must be model and maintain weight in accordance to some previous studies, Sebiany^[11] and Epling et al. in 2011,^[18] as the patients usually lose their trust if the physician advising them to lose weight and providing methods of that, is in fact obese and did not apply that methods on himself.

In this study, 50.4% of physicians used BMI for obesity classification in all health conditions, this agreed with Al-Shammari in 2014,^[7] although BMI is the most widely used method for classifying obesity, it had certain limitations, first it is not a direct method for measuring obesity, second the body fat is not accurately measured by BMI, for example, a female might have the same weight and height as a male, but females have more body fat than males.^[19]

Conclusions

In general, most of the physicians who were involved in the study had an adequate knowledge about obesity 92.2%, Less than 50% of our subjects answered incorrectly on two questions, <60% of our subjects answered incorrectly on three questions. The rest ten questions were correctly answered with a percentage ranges between 75% and 98% except one with a 65%.

Recommendations

The importance of more training courses about obesity and how to deal with obese patient physically and psychotically at the primary health-care centers

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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