RESEARCH ARTICLE Open Access
P ima y ca e obesi y managemen in Hunga y:
e alua ion o he knowledge, p ac ice and
a i udes o amily physicians
Im e Ru ik
1*
, Pé e To zsa
2
, Is án Ilyés
1
, End e Szige hy
1
, Esz e Halmy
3
, Gab iella Iski
1
, László Róbe Kolozs á i
1
,
Lajos Mes e
4
, Csaba Móczá
5
, Józse Rin el
6
, Lajos Nagy
6
and László Kalabay
2
Abs ac
Backg ound: Obesi y, a h ea ening pandemic, has an impo an public heal h implica ion. Be o e p ope
medica ion is a ailable, p ima y ca e p o ide s will ha e a dis inguished ole in p e en ion and managemen . Thei
pe o mance may be in luenced by many ac o s bu hei pe sonal mo i a ion is s ill an unde - esea ched a ea.
Me hods: The knowledge, a i udes and p ac ice we e e iewed in his ques ionnai e s udy in ol ing a
ep esen a i e sample o 10% o all Hunga ian amily physicians. In di e en se ings, 521 p ac i ione s (448 GPs and
73 esiden s/ oca ional ainees) we e ques ioned using a alida ed ques ionnai e.
Resul s: The knowledge abou mul imo bidi y, a main consequence o obesi y was balanced.
Only 51% o he GPs we e awa e o he diagnos ic h eshold o obesi y; awa eness being highe in ci ies (60%) and
he highes among esiden s (90%). They also conside ed obesi y an illness a he han an aes he ic issue.
The e we e wide di e ences ega ding a i udes and p ac ice, in luenced by he he doc o s’age, gende , known
BMI, p e ious quali ica ion, less by wo king loca ion.
GPs wi h quali ica ion in amily medicine alone conside ed obesi y managemen as highe p o essional sa is ac ion,
compa ed o physicians who had p e iously o he boa d quali ica ion (77% s 68%). They measu ed hei pa ien s’
wais ci cum e ence and wais /hip a io (72% s 62%) mo e equen ly, p o ided he obese wi h die a y ad ice
mo e o en, while his se ice was less equen among capi al-based doc o s who accep ed he sel - epo ed body
weigh da es by pa ien s mo e commonly. Simila educed ac i i y and weigh -measu emen in ou doo clo hing
we e mo e ypical among olde doc o s.
Diagnosis based on BMI alone was he highes in ci ies (85%). Consul a ions we e signi ican ly sho e in p ac ices
wi h a highe numbe o en olled pa ien s and we e longe by emale p o ide s who consul ed longe wi h
pa ien s abou he suspec ed causes o de eloping obesi y (65% s 44%) and o e ed die a y eco ds o pa ien s
signi ican ly mo e equen ly (65% s 52%). Mos o he younge doc o s ag eed ha obesi y managemen was a
p ima y ca e issue.
Doc o s in he no mal BMI ange we e unanimous ha hey should be a model o hei pa ien s (94% s 81%).
Conclusion: Mo e educa ion o p ima y ca e physicians, a ailable p ac ical guidelines and highe communi y
in ol emen a e needed o imp o e he obesi y managemen in Hunga y.
Keywo ds: A i udes, Family physician, Gene al p ac i ione , Hunga ian, Knowledge, Managemen , Obesi y,
O e weigh , P ac ice, Su ey
* Co espondence: [email p o ec ed]
1
Depa men o Family and Occupa ional Medicine, Facul y o Public Heal h,
Medical and Heal h Science Cen e , Uni e si y o Deb ecen, Nagye dei k .
98, 4032, Deb ecen, Hunga y
Full lis o au ho in o ma ion is a ailable a he end o he a icle
© 2013 Ru ik e al.; licensee BioMed Cen al L d. This is an open access a icle dis ibu ed unde he e ms o he C ea i e
Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/2.0), which pe mi s un es ic ed use, dis ibu ion, and
ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
Ru ik e al. BMC Family P ac ice 2013, 14:156
h p://www.biomedcen al.com/1471-2296/14/156
Backg ound
In Hunga y, as in many o he coun ies, o e weigh and
obesi y a e becoming an epidemic and hey a e espon-
sible o mos o he pa hologic condi ions [1,2]. Obesi y
epidemic is a challenge o public heal h and equi es
medical in e en ions, indi idual beha io modi ica ions
and en i onmen al changes [3]. Obesi y is an epidemic
among p ima y ca e pa ien s as well. While amily physi-
cians ca e o he consequences o obesi y, hey do no
gene ally eel con iden abou managing obesi y i sel
[4]. The majo i y o medical consul a ions ake place in
p ima y ca e se ings and gene al p ac i ione s (GP) ha e
an oppo uni y o obse e hei obese pa ien s’weigh
gain o decades [5,6]. The physician’s knowledge is a
basic ool which should be pe manen ly imp o ed. The
doc o ’s daily p ac ice in his a ea should be based on
guidelines and ecommenda ions; plen y a e a ailable
abou he complica ions o obesi y such as diabe es, ca -
dio ascula diseases and isks and hei managemen .
High p e alence o nega i e a i udes was ound, pa icu-
la ly among younge physicians and hose wi h lowe pa-
ien olume. B oade knowledge o weigh -loss die s was
associa ed wi h less dislike in discussing weigh loss, less
us a ion, g ea e us in he e icacy o ea men , and
less pessimism abou pa ien success [7]. Knowledge gaps
and ambi alen a i udes owa d obesi y managemen we e
ound among GPs in di e en coun ies. In addi ion, us-
a ion wi h he esou ces and s uc u e o cu en p ima y
ca e sys ems, o e bu dening o ou pa ien s consul a ion
p e en ed hem omdealingwi hobesi yin hep ope
way [4,8,9]. Many s udies no ed ha physician’s ecom-
mended heal hy li es yle (inc eased physical ac i i y), die -
a y ad ice (dec eased numbe o o al calo ies) o e e al
o a die ician bu a ely p o ided a p ac ical p og amme o
how o implemen hese ecommenda ions. I is ob ious
ha he e is a need o educa ion o p ima y ca e physicians
o inc ease he uni o mi y o he assessmen and imp o e
physicians’sel -e icacy in managing adul and childhood
obesi y [8,10]. Physicians o en epo a lack o con idence
in managing obesi y. Lack o pa ien mo i a ion is pe -
cei ed o be he g ea es ba ie . Physicians wi h g ea e
knowledge, mo e posi i e a i udes owa d obesi y manage-
men , and access o mo e esou ces a e mo e likely o p o-
ide weigh managemen in p ima y ca e se ings [11].
A sys ema ic e iew has ound ha obesi y is a s igma-
ized condi ion ha exe s a nega i e impac on he ela-
ionship be ween pa ien s and heal h-ca e p o ide s. The
p esence o obesi y a ec s heal h-ca e in e ac ions and
decision making [12].
Aim
The aim and esea ch ques ion o his s udy is o assess
Hunga ian gene al p ac i ione s’knowledge, a i udes,
p ac ices, hei in e ac ions and ind ba ie s wi h o he
ac o s ha in luence he physicians’willingness and
abili y o manage obesi y.
Me hods
S udy design
C oss sec ional su ey
An anonymous ques ionnai e based on a alida ed in e -
na ionally published ques ionnai e was de eloped and
alida ed again in own language by he p ima y ca e ex-
pe s o all Hunga ian medical acul ies [13].
Da a we e asked abou he doc o s’gende , age, wo k-
ing domicile, boa d speci ica ions, and p ac ice cha-
ac e is ics, demog aphy, numbe o en olled pa ien s.
The e we e ques ions ocussing on nume ical da a o
explo e how p ac i ione s es ima ed he a io o obese o
o e weigh pa ien s in hei p ac ice.
Al oge he 81 (mos ly mul iple choice) ques ions we e
asked in h ee main domains (knowledge, a i ude and
p o essional p ac ice). The esul s we e p esen ed in he
same way.
Se ings
Di e en educa ional e en s o amily physicians and
pa icipan s o a esidency p og amme in amily medi-
cine, o ganized by he ou depa men s o amily medi-
cine in Hunga y in 2011, whe e he p in ed e sion o
he ques ionnai e was dis ibu ed. Al oge he 523 ques-
ionnai e o GPs and 78 o esiden s we e deli e ed
bu only 448 and 73 was comple ed, eady o da a e-
co ding. I means a esponse a e o 86% and 92%
espec i ely.
Selec ion o pa icipan s
Pa icipa ion was olun a y wi hou any inancial
incen i es.
Exclusion c i e ia
Re usal o pa icipa ion o any eason o pa ially com-
ple ed ques ionnai e.
Da a sou ces
Comple ed ques ionnai e om GPs and esiden s.
Quan i a i e a iables
De i ed om he answe s gi en o he ques ionnai e.
Quali a i e a iables
Ou come o ac o ial analysis, desc ibing he cha ac e is-
ics o pa icipan s.
E hics
Acco ding o he ecen Hunga ian egula ions, su eys
among heal h p o essionals do no equi e p e ious e h-
ical pe mission [14].
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S a is ics
ANOVA, unpai ed and pai ed -, Fishe ’s exac - and chi-
squa e es s we e used in o de o explo e connec ions
be ween he answe s and he main cha ac e is ics o he
s udy popula ion. P < 0.05 was conside ed s a is ically
signi ican .
Fo mo e sophis ica ed compa ison ac o ial analysis
using Kaise -Meye -Olkin measu e was also pe o med
o desc ibe he esponden s’cha ac e is ics. Using a
dendog am, de i ed om he Wa d hie a chic way h ee
clus e s we e es ablished based on he ques ions ela ing
o he ollowing quali a i e cha ac e is ics:
–Sense o oca ion in he ea men o obesi y;
–P o essional skills in managing obesi y;
–Counseling o obese pa ien s.
All o he analyses we e pe o med using STATA 10.1.
so wa e (S a aco p LP. College S a ion, TX, USA).
Resul s
Desc ip i e da a
Al oge he 448 amily physicians (170 male and 278 e-
male) and 73 esiden s (18 male and 55 emale) com-
ple ed he ques ionnai e. The GPs’mean age was 54.5 ±
9.8 yea s, he younges and he oldes esponden s being
31 and 82 yea s old, espec i ely. The esiden s’mean
age was 29.9 ± 5.4 yea s.
The a e age numbe o en olled pa ien s in he p ac-
ices was 1675 ± 483. The e we e 308 p ac ices wi h
adul s popula ion and 56 amily pedia icians (ha ing
child en popula ion only (<14 yea s). In 84 p ac ices, all
gene a ions we e unde ca e. The geog aphical loca ions
o p ac ices we e as ollows: 119 in Budapes , 99 in big,
126 in smalle ci ies and 104 in illages.
The GPs spen 19.3 ± 11.2 yea s on a e age in he
p ac ice and he mean o boa d-quali ica ion was
1.9 ± 0.9. O hem 150 we e specialized in amily medi-
cine only, 199 had wo, 70 had h ee and 29 had mo e
boa d quali ica ions. I means ha hey s a ed hei
ca ie in o he p o essional ields, mainly in e nal medi-
cine, and la e on hey changed hei job/posi ion in
amily medicine and become quali ied in his ield as
well. The ecen an h opome ic cha ac e is ics o doc-
o s a e gi en in Table 1.
Ou come da a
In hei own p ac ices, he incidence o o e weigh
among adul s was es ima ed as 34.3%, ha o obesi y as
23.4%, wi h small di e ences be ween di e en ypes o
se lemen s. I was almos he same among child en.
Answe s and hei ela ion o he desc ip i e da a a e
p esen ed in 3 domains.
Knowledge
Ques ions ocusing o causes and consequences o obesi y
ied o explo e he GPs’knowledge. The e we e also
s a emen s and esponde s we e eques ed o ag ee o
disag ee wi h hem (Table 2). Ho monal, gene ic and en-
i onmen al ac o s we e a ed among he main causes
o obesi y, mainly long e m posi i e ene gy balance,
combined wi h physical inac i i y, besides impai ed psy-
chological condi ions. The e was a wide consensus abou
consequences and s a emen s as well.
Table 1 The mean o BMI, BMI ca ego ies and numbe o
esponde s
GPs Residen s
male emale o al male emale o al
BMI [kg/m
2
] 27.2 25.0 25.8 26.8 21.7
±SD 4.9 4.6 4.7 3.7 3.5
BMI ca ego ies [kg/m
2
]
Unde weigh (<18.5) 2 5 7 7 7
No mal (18.5-24.9) 56 158 214 7 41 48
O e weigh (25–29.9) 72 78 150 7 6 13
Obese (30 < ) 40 37 77 4 1 5
o al 163 274 448 18 55 73
Table 2 Knowledge on causes, consequences an
s a emen s o obesi y and dis ibu ion o answe s in his
domain
Knowledge Disag ee Ag ee
Causes o obesi y [%] [%]
Ea oo much a 11.0 89.0
Insu icien physical ac i i y 2.8 97.2
Gene ic ac o s 26.8 73.2
Repea ed die ing 41.6 58.4
S ess, anxie y and dep ession 21.5 88.5
Ho monal diso de s 22.9 77.1
Low income, unemploymen 54.3 45.7
Consequences o obesi y
Medical p oblems 4.9 95.1
Psychological p oblems 5.5 94.5
Social p oblems 15.8 84.2
S a emen s
Obesi y is a disease 11.5 88.5
No mal weigh is impo an in heal h 4.4 95.9
Fo o e weigh and obese pa ien s e en small
weigh loss can p oduce heal h bene i s
5.2 94.8
Mos o e weigh pa ien s should be ea ed o
weigh loss
9.9 90.1
Only obese pa ien s should be ea ed
o weigh loss
70.0 30.0
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The BMI h esholds o diagnosing o e weigh / obes-
i y we e de ined exac ly only by 51.3% o doc o s. Physi-
cians wo king in he capi al (37%) and illages (47%)
we e signi ican ly less p epa ed, han hei colleagues in
he ci ies (≈60%). Residen s who pa icipa ed in oca-
ional aining we e be e educa ed; mo e han 90% o
hem had a eliable knowledge on diagnos ic h esholds.
Younge doc o s we e mo e unanimous in conside ing
obesi y as an illness compa ed o hose who belie ed i
was a symp om only (53.9 ± 0.5y s 57.8 ±1.5y, p = 0.01).
S a emen
Se en y pe cen o he physicians disag eed ha body
weigh should be dec eased in obese pa ien s only. This
a io was 55.1% among pedia icians.
This app oach was in luenced by he doc o s’own
BMI. Al hough many ag eed ha weigh educ ion was
expec ed no only om obese pa ien s, only 46.7% o
doc o s wi h BMI o e 30 kg/m
2
had he same opinion
(p = 0.007). The mean age o hose who ag eed was
signi ican ly highe (56.2 ± 0.9 yea s s 53.7 ± 0.6 yea s,
p = 0.019).
A i ude
The GPs’di e en pe sonal a i udes, bias and p econ-
cep ions we e explo ed by using he ques ionnai e. Will-
ingness and sel -con idence we e qui e di e en as well
(Table 3).
The mean age o hose who belie ed obesi y could be
managed in p ima y ca e wi hou sending all obese pa-
ien s o specialis s was lowe (53.7 ± 0.5 yea s s 58.4 ±
1.1 yea s, p = 0.04).
Nine y- ou pe cen o doc o s in he no mal BMI
ca ego y ag eed ha amily physicians should be an
example in body weigh , while only 80.8% o obese doc-
o s ga e he same answe (p = 0.004).
T ea ing obesi y means a highe p o essional sa is ac-
ion o doc o s ha ing boa d quali ica ion in amily
medicine only compa ed o o he s who a e mo e quali-
ied (76.8% s 67.6%, p = 0.038).
The belie ha “Obese pa ien s a e lazie and mo e
sel -indulgen han people wi h no mal weigh ”was
suppo ed by 52.6% o obese and 67.9% o non-obese
doc o s (p = 0.01). The mean BMI o hose doc o s who
ag eed was 25.5 ± 0.21 kg/m
2
, while i was highe (26.5 ±
0.4 kg/m
2
) among hose who disag eed (p = 0.026). This
belie ega ding pa ien s in he o e weigh ca ego y was
suppo ed by 54.8% o obese doc o s and 65.8% o hose
who we e ca ego ized wi h lowe BMI (p = 0.036). Doc o s
who ag eed wi h his s a emen we e olde (55.1 ±
0.5 yea s) han hose who disag eed (52.7 ± 0.8 yea s,
p = 0.024).
P ac ice
The diagnos ic, ea men and consul a ion p ac ices
we e no uni o m. An h opome ic pa ame e s ela ed o
obesi y as diagnos ic ools we e conside ed di e en ly
(Table 4).
Diagnos ic me hods based only on inspec ion we e ac-
cep ed less equen ly by physicians quali ied in amily
medicine only, han by doc o s ha ing wo boa d exami-
na ions (16.1% s 24.8%, p = 0.049).
The diagnosis o obesi y based only on body weigh
measu emen was made mo e equen ly by doc o s who
ea ed only adul s, han by amily pedia icians (49.3 s
32.8, p = 0.045).
BMI-based diagnosis was highe in ci ies (84.7%). I was
only 71.2% in he capi al and 74.3% in illages (p = 0.002).
Wais ci cum e ence was conside ed mo e equen ly in
pedia ic han adul p ac ices (79.1% s 63.3%, p = 0.046).
I was p e e ed by doc o s quali ied in amily medicine
only compa ed o hose who had acqui ed mo e boa d
quali ica ions (71.8% s 61.7%, p = 0.035). Physicians wo k-
ing in he capi al elied on wais ci cum e ence measu e-
men s a ely in compa ison wi h doc o s in o he se ings
(57.0% s 66.1%, p = 0.038).
Wais /hip a io was calcula ed in 49.8% o adul and
64.2% o pedia ic p ac ices (p = 0.026). I was less com-
monly used in he capi al han in o he o se lemen s
(43.6% s 54.3%, p = 0.027). Olde doc o s ealized i s
impo ance be e han hei younge colleagues did
(56.2 ± 0.6 yea s s 52.1 ± 0.7 yea s, p = 0.002). Doc o s
ha ing boa d specializa ion / quali ica ion in amily
medicine only ega ded his app oach mo e impo an
han hei colleagues wi h wo quali ica ions (58.8% s
50.5%, p = 0.038).
Di e ences we e ound in he mean age o doc o s
accep ing sel - epo ed body weigh da a om pa ien s and
Table 3 GPs’s a i udes conce ning obesi y and obese
pe sons and dis ibu ion o answe s in his domain
A i udes Disag ee Ag ee
[%] [%]
GP’s ole is o e e o e weigh o obese pa ien s o
o he p o essionals a he han a emp o ea
hemsel es
83.7 16.3
GPs should be models and main ain no mal weigh 11.2 88.8
I eel well-p epa ed o manage o e weigh and
obese pa ien s
43.4 56.6
T ea ing o e weigh and obese pa ien s is
p o essionally g a i ying
29.5 70.5
Obese pa ien s a e lazie and mo e sel -indulgen
han people wi h no mal weigh
32.1 67.9
O e weigh pa ien s a e lazie and mo e sel -
indulgen han people wi h no mal weigh
34.4 65.6
Only a small pe cen age o o e weigh and obese
people can lose weigh and main ain his loss
20.4 79.6
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hose who insis ed on weighing hei pa ien s (55.3 yea s s
51.8 yea s, p = 0.002). This p ac ice was signi ican ly highe
in he capi al (p = 0.023).
Body weigh measu emen s in unde wea ins ead o
ou doo clo hing was p e e ed by olde (55.6 yea s s
53.7 yea s, p = 0.03) and unde weigh physicians and bu
ewe obese doc o s ollowed sui (68% s 37.5%, p = 0.04).
The numbe o boa d examina ions, being a esiden , loca-
ion and numbe o en olled pa ien s had no in luence on
his di e ence in he applied me hodology.
S ic educ ion in a in ake was emphasized by 86.0%
o male and 92.9% o emale physicians (p = 0.020) when
gi ing nu i ional ad ice. Ea ing (ha ing a snack) be ween
wo main meals was p ohibi ed mo e equen ly by doc-
o s wi h mo e quali ica ions (83.3% s 74.9%, p = 0.044).
They also ecommended pe sonalized low-calo ie die
mo e equen ly (83.3% s 74.9%, p = 0.044). The doc o s’
mean age p e e ing his ype o die was highe han ha
o hei colleagues who did no (57.5 ± 0.7 yea s s 53.2 ±
0.6 yea s, p = 0.014). Age was a signi ican con ibu o o
ag eeing o a oid some ene gy-dense dishes (55.2 ±
0.5 yea s s 52.3 ± 0.9 yea s, p = 0.004). Die a y ad ice was
p o ided less equen ly in he capi al han in o he se le-
men s (57.3% s 67.8, p = 0.026) and also less equen ly
by mo e quali ied doc o s (63.4% s 74.3%, p = 0.015). The
mean age o doc o s ealizing he impo ance o die a y
counseling was highe han ha o hose who did no
(55.3 ± 0.6 yea s s 52.7 ± 0.9 yea s, p = 0.010).
Doc o s p o ided e y di e en da a abou he
achie ed weigh educ ion o hei obese pa ien s ollow-
ing die a y counseling. No ela ion was ound be ween
he cha ac e is ic o p ac i ione s and epo ed ini ial de-
c ease in body weigh , exp essed in pe cen o he base-
line weigh . These da e se ed a basis o quali a i e
ac o ial (clus e ) analysis.
The heo y and suspec ed easons o de eloping obes-
i y we e discussed wi h he pa ien s mo e equen ly by
emale ca e p o ide s han male physicians (64.6% s
44.1%, p = 0.018). Fi y pe cen o he esiden s also
discussed his opic.
Nine y- h ee pe cen o he GPs ecommended weigh
educing p og ammes ou inely. This igu e was lowe
(83.0%) among amily pedia icians. Doc o s ha ing a
highe numbe o en olled pa ien s (abo e 1.600) p o-
ided die a y ad ice in a lowe a io (p = 0.06). Phone
in e iew wi h pa ien s, o moni o hei achie emen in
weigh educ ion was used by 22.8% o GPs.
Pe sonalized physical ac i i y p og ammes we e
ecommended by only 32.6% o he physicians. Female
doc o s consul ed signi ican ly longe wi h hei obese pa-
ien s and consul a ions we e signi ican ly sho e in p ac-
ices wi h a highe numbe o en olled pa ien s (means:
12.1 s 9.6 minu es). These igu es we e 10 s 6 minu es
by esiden s, espec i ely.
The as majo i y o he doc o s (96.3%) le hei pa-
ien s know abou he expec ed changes in body weigh .
The ecommended change in body weigh wi hin
6 mon hs was 9.3 ± 6.6 pe cen o baseline body weigh .
Following a die ecommended and ad e ised in he
media was suppo ed mo e equen ly by male physi-
cians (6.8% s 2.5 %, p = 0.038), while hei emale
colleagues qui e o en asked hei pa ien s o keep a
eco d o he ood hey had consumed (64.8% s 51.9%,
p = 0.009).
Ou comes o he ac o ial (clus e ) analysis
Based on he cha ac e is ics o in e es , he GPs we e
di ided in o h ee g oups as ollows:
Clus e 1. The smalles g oup (3%), consis ed mainly
o male physicians, usually wi h adul popula ion in he
capi al. They spen he longes ime in he p ac ice
(mean: 22 yea s) and had he sho es consul a ion ime
wi h hei obese pa ien s. They a e less e ec i e (3.5% o
ini ial body weigh ) in he epo ed weigh dec ease o
Table 4 Diagnos ic p ac ice, ad ice gi en and ools used
by GPs in he managemen o obesi y wi h he
dis ibu ion o answe s in his domain
P ac ices Disag ee Ag ee
Diagnos ic me hods [%] [%]
Weigh wi hou e e ence o heigh 54.9 45.1
BMI calcula ion 20.9 79.1
Wais / hip a io 44.4 55.6
Wais measu emen s 34.9 65.1
Compa ison wi h ideal weigh 30.2 69.8
Appea ance 77.9 22.1
Weigh managemen ad ice and ools
Ea less du ing meals 12.9 87.1
Ea less a 10.2 89.8
Don’ ea be ween meals 23.3 76.7
Ea less suga 6.7 93.3
Ea mo e ui s and ege ables 3.7 96.3
Consume ewe calo ic d inks 5.3 94.7
De ini ely a oid speci ic oods 31.0 69.0
Follow pe sonalized low-calo ie die
(1200–2200 kcal/day)
17.0 83.0
Follow e y low calo ie die
(<1200 kcal/day)
72.9 27.1
Follow comme cial /ad e ised die 96.2 3.8
Exe cise /spo 6.4 93.6
Do mo e exe cise in e e yday li e
(e.g. walking, ga dening)
4.4 95.6
Lea le s on heal hy beha io 41.5 58.5
Food dia y 40.3 59.7
Nu i ional educa ion 32.8 87.2
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hei pa ien s. They ha e he lowes a ing in oca ion,
p epa edness and consul a ions.
Clus e 2. Abou one hi d o he doc o s, mainly men,
wi h he highes a io o pedia ic and mixed pa ien
popula ion. They spen less ime in p ac ice (mean:
20.5 yea s), and could be cha ac e ized wi h a e age
leng h o consul a ion ime, in oca ion, p epa edness
and leng h o consul a ion. They we e less e ec i e in
weigh educ ion (13.7%) and go lowe a ing in p o id-
ing hei pa ien s wi h ad ice.
Clus e 3. I is he la ges g oup, co e ing wo hi ds
o he popula ion. The doc o s a e mainly women
wi h adul p ac ices and o he ypical geog aphical
dis ibu ion. These doc o s ha e spen he sho es
ime in p ac ice (mean: 17.3 yea s). The leng h o
consul a ions exceeds he a e age a bi . As a as
achie emen is ega ded, p ac ices in his clus e a e
he bes (15%). The physicians’ oca ion and p e-
pa edness a e highe han a e age and hey a e also
he bes in counseling.
Discussion
Key esul s
The esponde s’knowledge was di e en in some do-
mains. The e we e many inconsis en indings and only
ew signi ican ela ions. Beside p e ious p ac ice and e-
cen knowledge, he physicians’own li es yle and BMI
had a high impac on hei a i udes and in luenced hei
ac ual p ac ice mo e han wo king loca ion.
Compa ison wi h p e ious esea ch
Di e en ypes o pape s, quali a i e and quan i a i e
we e also ound, bu , un o una ely mos o hem we e
incompa able. All he p e ious s udies ep esen ed
smalle , geog aphically close se ings e en om la ge o
con inen -wide coun ies [13,15,16].
Despi e inc easing knowledge on obesi y- ela ed pa h-
ologies he e we e only small changes in he daily p ac ice
o doc o s. Pe sonal a i udes owa d obesi y ha e a g ea
impac on p o essional p ac ice o doc o s. In coun ies
wi h mo e ad anced le el o p ima y ca e o he heal h
p o essionals a e also in ol ed in he managemen o
obesi y. Heal h isi o s, quali ied nu ses can con ibu e
be e in he p e en ion p o iding hei pa ien s wi h nu -
i ional and li e s yle ad ice [17]. In Hunga y, only one
p ac ice nu se is employed by he GP.
P ima y heal h ca e p o ide s in some epo ed coun-
ies like Canada, he UK and he USA a e no adequa ely
equipped o deal wi h he pedia ic obesi y epidemic as
ye [18-20].
In Hunga y, mul idisciplina y guidelines do no speci -
ically add ess amily physicians; adhe ence is low in gen-
e al and GPs a e no mo i a ed inancially. The e is a
need o a p ac ical p ima y ca e guideline. Guidelines
conside obesi y as a complica ion a he han an en i y.
The la es guideline on obesi y is no a ailable o all
GPs and hei knowledge, p ac ice and pe sonal a i udes
a e qui e di e en [21]. In he o me unde g adua e
medical cu iculum in Hunga y, a ended mainly by he
“olde ”gene a ion o GPs, obesi y was no desc ibed as
being a pa hologic condi ion. Subs an ial p opo ion o
p ac icing GPs wo ked p e iously in hospi als, acqui ed
a boa d speci ica ion, mainly in e nal medicine and
he ea e applied o a job in p ima y ca e. The daily
p ac ice o his gene a ion o doc o s is based mainly on
pe sonal expe ience and a ely on guidelines. I could
be a eason why olde doc o s wi h highe own body
weigh /BMI a e less ac i e in he obesi y managemen .
Younge GPs usually pa icipa ed in a esidency p og am
o amily medicine. Mo eo e , guidelines do no ha e so
g ea impac on p o essional p ac ices o physicians in
Hunga y as hey do in o he coun ies.
La ge s udies has iden i ied p o ide sys em and pa-
ien ba ie s o obesi y ca e. Lack o obesi y aining
du ing medical school and esidency has been associa ed
wi h signi ican ly lowe a es o discussing die and exe -
cise wi h obese pa ien s [22-24].
The cu en p ac ice o weigh managemen and he
a i udes and possible ba ie s owa ds ea men o
o e weigh and obesi y a e no uni o m [3]. Age, he
physician’s gende , he physician’s weigh , p ac ice loca-
ion, and cu en aining s a us a e all associa ed wi h
some aspec s o he physician’s a i udes and ea men
p ac ices [25].
Syn heses o he indings om he selec ed s udies
sugges ha doc o s and nu ses o no mal weigh a e
mo e likely o use s a egies o p e en obesi y and gi e
gene al ad ice o achie e weigh loss han hose who a e
o e weigh . The doc o s’and nu ses’own weigh s a us
was no closely ela ed o hei e e al and assessmen
o o e weigh o obese pa ien s. Associa ions wi h hei
ele an knowledge/skills and speci ic ea men beha -
io s we e inconsis en and a he same ime, pa ien s’
lack o mo i a ion was men ioned as a main ba ie o
success ul ea men [4,7,9,11,16,23].
S eng hs and limi a ions o he s udy
Ou e alua ion was based on he na ion-wide samples o
Hunga ian amily physicians wi h high ep esen a ion o
di e en esidency ( om he capi al o he small illages)
and age coho o GPs. Almos 10 % o Hunga ian GPs
in p ac ice we e ques ioned so hei answe could be
conside ed as ep esen a i e. Dis ibu ion o he p ac ice
popula ion o he ques ioned doc o s was simila o he
es ima ed Hunga ian p e alence o obesi y [1,2,26-28].
One o he limi a ions is ha only he knowledge and
a i udes o he esiden s could be e alua ed, as hey
ha e a limi ed indi idual p ac ice only.
Ru ik e al. BMC Family P ac ice 2013, 14:156 Page 6 o 8
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Sel - epo ed da a do no always e lec he daily clin-
ical p ac ice and a i udes a e o en in luenced by he
daily wo kload in p ac ice and he doc o ’s ac ual mood.
In o de o achie e he highe pa icipa ion a e, only
c oss sec ional s udy we e conduc ed. Unexpec ed ind-
ing, ha GPs ha ing mo e quali ica ion had o en lowe
pe o mance was no e alua ed.
Conclusion
E ec i e assessmen ools and ea men esou ces, dis-
semina ion o clinical p ac ice guidelines, enhanced
unde g adua e medical educa ion and pos g adua e con-
inuing medical educa ion, and sys em-le el changes a e
u gen ly needed o add ess his heal h p oblem.
Despi e he g owing wo ldwide epidemic o obesi y,
weigh managemen is no adequa ely add essed in p i-
ma y ca e, e en no in Hunga y.
New s a egies should be de eloped o b eak down he
GP’s ba ie s o weigh managemen and o s imula e
changes in GP’s a i udes.
Mo e educa ion o p ima y ca e physicians, speci ic
examina ion echniques, and a ailabili y o communi y
esou ces o obese pe sons is needed. Fu he esea ch
is needed o de e mine i in e en ions o inc ease he
physicians’knowledge will lead o less nega i e a i udes
owa d weigh loss and ex emely obese pa ien s.
Compe ing in e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
Au ho s’con ibu ions
IR and PT planned he s udy; hey collec ed he mos ele an li e a u e,
o ganized he expe g oup and ex w i ing, including inal edi ing.
Toge he wi h hem, II, EH, LN and LK we e he expe g oup membe s using
hei own li e a u e sea ch and hey con ibu ed in ex w i ing as well.
Dissemina ion and co esponding o he ques ionnai e was pe o med by IG,
LRK, LM, CsM and JR wi h da a collec ion and local/na ional li e a u e and
da a sea ch. All he da a analysis and s a is ics was pe o med by ESz. All
au ho s ead and app o ed he inal manusc ip .
Acknowledgemen s
Au ho s hank he suppo om M s. Jusz ina N. Jánossy
1
in he English
co ec ion and he con ibu ion o M s. Judi Rusznyák
1
in da a eco ding.
Funding
Depa men al esou ces om he pa icipa ing uni e si ies, wi hou any
comme cial suppo .
Au ho de ails
1
Depa men o Family and Occupa ional Medicine, Facul y o Public Heal h,
Medical and Heal h Science Cen e , Uni e si y o Deb ecen, Nagye dei k .
98, 4032, Deb ecen, Hunga y.
2
Depa men o Family Medicine, Facul y o
Medicine, Semmelweis Uni e si y, Budapes , Hunga y.
3
Hunga ian Socie y o
he S udy o Obesi y, Budapes , Hunga y.
4
Ins i u e o Family Medicine,
Facul y o Medicine, Uni e si y o Szeged, Szeged, Hunga y.
5
I inyi P ima y
Heal h Ca e Cen e , Kecskemé , Hunga y.
6
Ins i u e o Family Medicine,
Facul y o Medicine, Uni e si y o Pécs, Pécs, Hunga y.
Recei ed: 1 Augus 2013 Accep ed: 15 Oc obe 2013
Published: 19 Oc obe 2013
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doi:10.1186/1471-2296-14-156
Ci e his a icle as: Ru ik e al.:P ima y ca e obesi y managemen in
Hunga y: e alua ion o he knowledge, p ac ice and a i udes o amily
physicians. BMC Family P ac ice 2013 14:156.
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