title: Type 2 diabetes patients' perspectives on lifestyle counselling and weight management in general practice: a qualitative study.
abstract: BACKGROUND
  Lifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients' weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients' preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition.
  
  
  METHODS
  Narrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method.
  
  
  RESULTS
  Many patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs' advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care.
  
  
  CONCLUSIONS
  Ambivalence towards patient self-management and tensions between the necessary changes to patients' lifestyles and their culture, makes the GP's role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients' capabilities of self-management through open communication and accept their patients' wishes to protect nutrition as part of their culture.
authors.affiliation: Department of General Practice/Family Medicine, University Medical Center Göttingen, Göttingen, Germany. matthias.wermeling@med.uni-goettingen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wermeling
authors.forename: Ulrike
authors.initials: U
authors.lastname: Thiele-Manjali
authors.forename: Janka
authors.initials: J
authors.lastname: Koschack
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lucius-Hoene
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Himmel
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D058006:General Practice; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D036301:Qualitative Research; D012648:Self Care