Chapter One: Introduction

Study Background

Chronic diseases are a major source of burden to the United Kingdom’s healthcare system. The Office for National Statistics (2020) indicates that more than 40% of people aged 65 and above in England suffer from different types of chronic diseases like cardiovascular diseases, diabetes, hypertension, stroke, and cancer, with obesity and overweight being major risk factors not only in the UK but also worldwide (Pearce et al., 2019; McHale et al., (2020), hence, a significant public health concern. An adult is considered obese if they have a body mass index (BMI) of 30 kg/m2 or more caused by an excessive accumulation of body fat, usually 20% beyond the limits of physical requirement leading to an increase in body weight to the degree that it might adversely affect wellbeing (Agha and Agha, 2017; WHO, 2021; House of Commons, 2021). In many cases, it affects the person’s ability to perform many of the tasks required for physical activities due to strain on their body. Likely causes of obesity range from genetics, physical inactivity, unhealthy diet, emotional and mental health problems (Public Health England, PHE, 2017).

Statistics show that over 39% of adults are overweight globally, while more than 13% suffer from obesity (WHO, 2021). In England, cases of obesity and overweight went up by 23%, from 711,000 in 2018 to 876,000 in 2019 (House of Commons, 2021). Moreover, McHale et al. (2020) found out that obese patients consult primary care more frequently than individuals suffering from other illnesses. It is estimated that there was a 17% increase in hospitalisations linked to obesity in 2019/2020, with over one million people being admitted to hospitals across the UK. Increasing prevalence is directly linked to increasing healthcare costs, and it is projected that the NHS will incur 9.7 billion pounds annually by 2050 (PHE, 2017).

Research strongly points out that obesity is linked to reduced quality-adjusted life expectancy, prompting the development of guidelines for identification and management of obesity (NICE, 2014), policies and campaigns such as Sport England (SE) and recently DOH (2020) ‘call to action campaign’ and Public Health England’s Better Health campaign (PHE, 2021). Furthermore, the NHS (2017) guidelines require that the preventive care integrated with treatment or control of obesity-related diseases be accessible to everyone regardless of health status or age. Concurrently, the WHO (2021) stresses the importance of obesity prevention to reduce the prevalence of non-communicable diseases. Practices aimed at preventing obesity and overweight and those intended to achieve weight loss among the overweight individuals cumulatively contribute to an overall decrease in obesity prevalence (Pearce et al., 2019). As such, nurses should care for patients with obesity through preventive measures and by helping overweight individuals lose weight in the population. Nurses form a critical part of primary care as they coordinate with a multidisciplinary team to care for obese people in the community and hospitals (Braga et al., 2017). Obesity management and care involve health promotion to prevent obesity and treat or control obesity-related diseases (Zhu et al., 2013; Kelly et al., 2016).

Furthermore, nurses educate and counsel patients on the importance of weight management and healthy living (RCN, 2021). Various studies postulate that nurses can also advocate for policies that encourage weight management and obesity prevention (Kelly et al., 2016). Such policies may involve government funding of activities such as gym subscriptions or rewarding health outcome goals such as weight loss (Braga et al., 2017). Other roles of nurses in obesity management may involve advocating for the government, insurance companies, and professional bodies to formulate more policies that remove barriers to obesity management services access. Therefore, nurses are an integral part of obesity management in hospitals and within the community. The current integrative literature review explores the role nurses play in obesity management at the primary care level in the UK.

Focus and Scope of the Study

Obesity management involves nurses, but it entails a multidisciplinary effort within the healthcare system. However, this integrative literature review will focus on nurses’ role in promoting obesity management practices at the primary care level. Equally, the study will not focus much on the patient’s role although, it may mention the role of the patient-nurse relationship in obesity management. Accordingly, the study will explore the nurses’ attitudes and perspectives on obese people and other factors influencing their role in obesity management and control.

Significance of the Study

Obesity and overweight management are a priority in the UK due to the high obesity prevalence, especially among adults and adolescents. This reality highlights the crucial role nurses and other healthcare professionals play in the healthcare system. However, much of the existing literature on the role of nurses in obesity management does not give special attention to the UK health system (Braga et al., 2017). Besides, most of the studies generalise the role played by healthcare providers in obesity management and prevention without a specific focus on nurses (Pearce et al., 2019). One of the studies examining healthcare providers’ perspectives and beliefs on weight management in the UK revealed that they were less enthusiastic about obesity management practices (McHale et al., 2020). As a result, there is an urgent need to focus more on the obesity management practices in the UK and how nurses handle them. The current study adds to the existing literature by integrating previous research on hospital practices in obesity management, with a specific focus on the role of nurses in primary care.

Consequently, the study is significant to the nursing profession as it will provide more insights into the facilitators and barriers to quality obesity management service provision. It will also help the relevant stakeholders understand the attitudes and perceptions of nurses towards obese individuals and how they affect service provision. In addition, policymakers and professional bodies like NICE may find this study helpful in formulating the relevant guidelines for nurses to promote obesity management practices. The study may further benefit scholars and students who may want to explore the topic in future.

Research Questions

The study applied the PICO (Population, Intervention, Comparison, and Outcome) framework to formulate a focused research question. Studies indicate that using PICO to frame a research question enhances conceptual clarity and specificity of the clinical problem (Eriksen and Frandsen, 2018). In addition, Aveyard and Bradbury-Jones (2019) posit that the PICO framework enables the researcher to identify the keyword, thereby aiding in the literature search by generating more precise results. Therefore, the framework was essential in this review to help formulate a clear and precise research question regarding current nursing practices around obesity management. The table below shows how the PICO framework developed the research question.

Population	Intervention	Comparison	Outcome
Obese patients	Current nursing practices at primary care	Null	Obesity management

Table 1: PICO framework for the research question (Source: Researcher)

Consequently, the main research question is: what are the current nursing practices around obesity management at the primary care level in the United Kingdom? Therefore, the study will seek to address the following specific research questions:

What are the barriers and facilitators to effective nursing practices regarding obesity management at primary care?
What are the primary care nurses’ perceptions and opinions on caring for people living with obesity?
How do primary care nurses identify and care for people living with obesity in hospitals?

Research Aim and Objectives

The study aims to explore the current nursing practices for managing obesity at primary care in the UK. Accordingly, the study seeks to achieve the following objectives:

To find out the factors influencing primary care nursing practices concerning obesity.
To explore primary care nurses’ attitudes towards people living with obesity.
To determine how nurses identify and manage patients living with obesity in primary care.
To identify what primary care nurses are doing to support people living with obesity.