title: Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities.
abstract: BACKGROUND
  Obesity is a top-priority global health issue; however, a clear way to address obesity in primary care is not yet in view.
  
  
  OBJECTIVE
  To conduct a meta-ethnography of patient and primary care practitioner perspectives of roles and responsibilities in how to address obesity in the UK, to inform evidence-based services that are acceptable to, and appropriate for, patients and practitioners.
  
  
  METHODS
  Qualitative synthesis applying meta-ethnographic methods according to the Noblit and Hare monograph. Database searches in MEDLINE(®), Social Sciences Citation Index(®), CINAHL, and Health Management Information Consortium were limited to 1997-2012 to examine recent perspectives.
  
  
  METHODS
  Full articles of practitioner and/or patient perspectives on obesity services in primary care were reviewed, and included semi-structured or unstructured interviews and focus groups, and participant observations.
  
  
  RESULTS
  Nine studies were synthesised with perspectives from patients (n = 105) and practitioners (n = 144). Practitioners believe that patients are responsible for obesity, and that primary care should not help, or is poorly equipped to do so. Patients 'take responsibility' by 'blaming' themselves, but feel that practitioners should demonstrate more leadership. The empowerment of patients to access health services is reliant on the empowerment of practitioners to take an unambiguous position.
  
  
  CONCLUSIONS
  Primary care has the potential either to perpetuate or counter obesity-related stigma. There needs to be a firm decision as to what role primary care will take in the prevention and treatment of obesity. To remain ambiguous runs the risk of losing patients' confidence and adding to a growing sense of futility.
authors.affiliation: Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen's Campus, Stockton on Tees.
authors.forename: Emily
authors.initials: E
authors.lastname: Henderson
mesh_terms: D055317:Evidence-Based Practice; D006801:Humans; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010819:Physician's Role; D058007:Physicians, Primary Care / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012941:Social Responsibility; D006113:United Kingdom
keywords: meta-ethnography; obesity management; patient perspectives; practitioner perspectives; primary care; qualitative synthesis
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