What goes into discussing referral and treatment options? A qualitative study of primary care staff reflections on supporting adults living with obesity.

Background: Policy and National guidelines place healthcare professionals (HCPs), particularly those employed in Primary Care, in a key role to assist with weight management. Previous research has acknowledged a number of practice barriers present for HCP in this role. An understanding of HCPs practice during healthcare appointments with adults living with obesity is necessary for the development and delivery of effective weight management initiatives. Aim: The primary aim of this qualitative study was to explore how primary care staff support adults living with obesity, from the initial discussion regarding weight to exploring treatment options. Secondary aims were to explore any factors that might influence staffs’ ability to work effectively with this population. Method: A qualitative study design using semi-structured interviews with a sample of 15 HCP including general practitioners (N=5), nurses (N=4), pharmacist prescribers (N=2), dietician (N=1) and Health and Wellbeing practitioners (N=3). Staff were recruited through the regional Clinical Research Networks. Reflexive Thematic Analysis was used to analyse how HCP work with adults living with obesity. Results: Six themes and 15 subthemes were identified: It’s not all about weight: Holding the discussion with the person in the room; Fostering a respectful and stigma-free environment; Weight is only one piece of the treatment puzzle; The struggle of navigating weight management systems; The problem with contemporary weight narratives; and the route to knowledge and expertise. Conclusion: The results of this study highlighted HCPs' dedicated efforts to support adults living with obesity. Those interviewed recognised their role in weight management and described ways they facilitated open, safe discussions about weight. Strategies included inviting individuals to discuss weight and health, listening to the patient's full story, and fostering engagement and motivation in weight management efforts. These discussions helped create tailored, holistic treatment plans focused on achievable, realistic, patient-centred health goals. HCPs also acknowledged the impact of weight stigma on these conversations, emphasising the importance of mindful language and rapport-building. However, they spoke of the challenges to preventative healthcare caused by societal narratives and organisational factors, including lack of training, limited specialist services, rigid referral criteria, and long waiting lists. As a result, there are a number of clinical implications and recommendations that could be made considering these findings.