Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review

Evan Atlantis; Ritesh Chimoriya; Canaan Negash Seifu; Kath Peters; Gill Murphy; Bernadette Carr; David Lim; P Fahey

doi:10.1136/bmjopen-2022-063659

Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review

BMJ Open. 2022 Nov 29;12(11):e063659. doi: 10.1136/bmjopen-2022-063659.

Authors

Evan Atlantis^{1

2

3}, Ritesh Chimoriya^{4

2

5}, Canaan Negash Seifu⁴, Kath Peters^{2

6}, Gill Murphy^{2

6}, Bernadette Carr⁷, David Lim⁴, P Fahey^{4

2}

Affiliations

¹ Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia E.Atlantis@westernsydney.edu.au.
² Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia.
³ Discipline of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Schoolof Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia.
⁵ Schoolof Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
⁶ Schoolof Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia.
⁷ TheUniversity of Sydney, Sydney, New South Wales, Australia.

Abstract

Objectives: This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice.

Design: A mixed-methods systematic review.

Data sources: Medline, Embase and CINAHL to November 2021.

Eligibility criteria: Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation.

Data extraction and synthesis: We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I²), publication bias (Egger's test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis.

Results: We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I² 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I² 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I² 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I² 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I² 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system.

Conclusions: Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.

Keywords: PREVENTIVE MEDICINE; PRIMARY CARE; QUALITATIVE RESEARCH; Quality in health care.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Anthropometry
Body Mass Index
Ethnicity*
Female
Humans
Obesity* / epidemiology
Odds Ratio