How should the obese patient be managed? Possible approaches to a national obesity management network V Hainer Obesity Management Centre, General Faculty Hospital, 3rd Department of Internal Medicine, Charles University, Prague, Czech Republic There is clearly a need for novel approaches to obesity and its management. This has been addressed by the Czech Society for the Study of Obesity, which established a multi-level obesity management network in response to the increasing prevalence of obesity in the Czech Republic. This network includes obesity management centres attached to major teaching hospitals, combined with input from obesity specialists, other specialists, primary healthcare physicians and weight reduction groups. Such an obesity management system aims to provide appropriate diagnostic and treatment facilities for various degrees of obesity throughout the country. The proposed density of the obesity management network takes into account the limited resources in the healthcare system. The network is designed to overcome the current poor level of understanding of obesity and the lack of time and financial resources which have been the most significant barriers to more involvement of primary care physicians in obesity management. In order to implement this system, a comprehensive education programme on obesity was initiated with postgraduate courses for obesity specialists and with training for counsellors of weight reduction groups. Keywords: obesity; management; obesity management programme; education; prevention Prevention and management of the global epidemic of obesity According to a World Health Organisation (WHO) report, obesity is rising to epidemic proportions in both developed and developing countries around the world. 1 In order to prevent further increases in the prevalence of obesity, national prevention pro- grammes are required which should involve both government organisations and the individual. Such programmes should employ a wide range of approaches including educational initiatives and local community activities. Organisations such as the healthcare system, food manufacturing and dis- tributing companies, agricultural agencies, the media and organisations providing leisure activities should also be involved. The implementation of effective measures for obe- sity prevention should be tackled by society as a whole. In contrast, effective obesity management depends in particular on healthcare providers who need unambiguous support from the government and healthcare authorities for effective implementation of the obesity management programme. However, weight management programmes have frequently encountered obstacles, which have prevented their effective implementation. Obstacles to effective implementation of obesity management programmes There are many obstacles to the implementation of effective obesity management programmes. Firstly, although obesity is a serious health problem, the prevalence and burden of obesity has been under- estimated not only by the general public and health policy makers but also by healthcare providers. For example, despite the high prevalence of obesity in Germany, an analysis of health insurance data revealed that obesity was documented in a very small percentage of medical records in out-patient clinics. 2 A poor understanding of obesity among physicians represents the most important obstacle to the imple- mentation of effective measures for obesity manage- ment. 3 Many physicians see their obese patients as weak-willed, ugly and awkward. 4 Due to their poor understanding of the pathogenesis of obesity, many physicians accept a simplistic view of obesity as being a result of overeating. This adversely affects their management of patients. A consultation with an obese patient should include a precise analysis of eating Correspondence: Professor Vojteˇ ch Hainer, Obesity Management Centre, General Faculty Hospital, First Medical School, Charles University, Ke Karlovu 2, 12109 Prague 2, Czech Republic. International Journal of Obesity (1999) 23, Suppl 4, S14–S19 ß 1999 Stockton Press All rights reserved 0307–0565/99 $12.00 http://www.stockton-press.co.uk/ijo