Knowledge, Attitudes, and Practices of Primary Care Physicians (PCPs) in Managing Obesity

Abstract

Background: Obesity is a chronic, relapsing disease associated with substantial cardiometabolic morbidity and premature mortality, yet it remains under-addressed in many primary care settings, particularly in low- and middle-income countries. Primary care physicians (PCPs) play a pivotal role in early identification, counseling, pharmacologic management, and referral for advanced obesity care. However, gaps in knowledge, attitudes, and clinical practices may limit effective implementation of evidence-based management strategies in routine care. Objective: To assess the knowledge, attitudes, and practices (KAP) of PCPs regarding obesity management at Timergara Teaching Hospital (TTH), Dir Lower, Pakistan, and to evaluate associations between physician characteristics and KAP scores. Methods: A descriptive cross-sectional study was conducted among 46 certified PCPs providing direct patient care. Data were collected using a validated 50-item structured questionnaire covering demographics, knowledge, attitudes, practices, and perceived barriers. Composite domain scores were calculated, and comparisons across physician characteristics were performed using independent-samples t-tests and chi-square tests. Effect sizes and 95% confidence intervals were computed where appropriate, with statistical significance set at p < 0.05. Results: While 83.3% of physicians recognized obesity as a chronic disease, only 49.1% reported routinely addressing obesity during consultations. Formal obesity-related training was significantly associated with higher knowledge scores (3.95 ± 2.16 vs 2.32 ± 2.04; p = 0.04) and more favorable attitudes (4.59 ± 1.12 vs 3.96 ± 1.18; p = 0.03). However, differences in practice scores were not statistically significant. Advanced management strategies, including pharmacotherapy (6.5%) and bariatric referral (8.7%), were rarely utilized. Conclusion: Although PCPs demonstrated awareness of obesity as a chronic disease, substantial gaps persist in structured management practices. Formal training improves knowledge and attitudes but does not fully translate into clinical implementation, highlighting the need for integrated educational and system-level interventions to strengthen primary care obesity management.