OPINION: Many medical professionals wrongly assume the growing ranks of overweight and obese Australians are not sufficiently motivated to lose weight. Instead, our research suggests low health literacy may be the culprit.
That is, a poor understanding of their own health, the measures they can take to improve it, and of the help the healthcare system can offer them, is frustrating the will to slim down.
Studies show about three in five Australians have less than ideal health literacy while one in five have very poor health literacy.
Patients with low health literacy are at higher risk or poor health because they are more likely to delay seeking care, are less likely to receive preventive care and have difficulty navigating between services and providers.
This translates into reduced life expectancy and a poorer quality of life. It also partly explains why Australia is today ranked as one of the fattest nations in the developed world.
While there are strong associations between poor health literacy, low socio-economic status and obesity, the cause and effects aren’t yet clear. My team and I are attempting to unpack this complex issue. We are looking at how best to help people who are both overweight and have little understanding of their own health and the services available within the healthcare system.
My team and I are working with one of the main groups responsible for preventive care – our General Practitioners (GPs). GPs have an accepted role in helping patients manage their weight especially where there are early signs of complications from being overweight such as high blood pressure or diabetes.
Our research is showing that GPs and practice nurses can do much better when it comes to supporting patients, particularly those with poor health literacy, to beat the bulge.
We recently conducted a study with GPs and practice nurses in twenty practices in socio-economically deprived areas in Sydney and Adelaide. We looked at their assessment and management of overweight and obese patients and their attitudes and strategies for managing patients with low health literacy.
Few reported assessing a patient’s health literacy. This is important because, in previous research, we have found that health professionals often confuse low health literacy with motivation. Patients with low health literacy appear less engaged, ask fewer questions and are less likely to follow treatment plans.
More than half of the GPs and practice nurses (PNs) reported regularly assessing diet, physical activity and Body Mass Index (BMI). While most provided brief advice, goal setting and referral was less frequently reported. A patients’ level of health literacy was also infrequently assessed. Of most concern was that only 15% reported being successful in treating obese patients and only 26% enjoyed treating obese patients.
Sound National Health and Medical Research Council (NHMRC) obesity management guidelines are already available based on five key steps: ask, assess, advise/agree, assist and arrange. Different health teams may work at each step to implement specific strategies to improve the effectiveness of obesity treatment and management for patients with low health literacy.
There are also simple tools available to assess health literacy so that clinicians can identify patients at risk.
- GPs and PNs can check understanding by asking patients in their own words what they have understood;
- After looking at a patient diary and agreeing on specific clear goals, options for referral to lifestyle programs can be discussed;
- After providing clear “navigation” help which explains the ‘why, what and how’ to the patients, this can be followed via by a phone call and a return visit to the GP.
But unless clinicians are routinely using these guidelines the problems remain. That means we must tackle some of barriers that frustrate doctors and practice nurses, particularly time pressures and difficulties dealing patients who seem disengaged.
We are currently assessing how these guidelines can be best incorporated into GP practices and what support regional primary care organisations need to provide to practices. This is especially important for practices in low socioeconomic areas where staff may have greater time pressures.
In this age when we are drowning in information about lifestyle and weight management, it is important that people with low health literacy are not left behind. Obesity levels in lower socioeconomic groups in Australia already clearly exceed those in higher socioeconomic groups and the disparity is widening (9). Tailoring our approach to the needs of those with low health literacy is part of the solution to reversing this trend.
Professor Mark Harris is Executive Director of UNSW’s Centre for Primary Health Care and Equity and Director of the Centre for Obesity Management and Prevention Research Excellence in Primary Health Care.
A version of this article was first published in The Daily Telegraph.