obesity has reached epidemic proportions globally , with more than 1.4 billion adults overweight200 million men and nearly 300 million women obese  and is a major contributor to the global burden of chronic disease and disability . often coexisting in developing countries with undernutrition , obesity is a complex condition , with serious social and psychological dimensions , affecting virtually all ages and socioeconomic groups . india is undergoing an epidemiologic transition in which chronic conditions replace communicable disease as major causes of morbidity and death . evidence indicates that adiposity is increasing in india that it is associated with cardiometabolic risk factors , diabetes , and cardiovascular disease ( cvd ) ; and that mortality from these conditions is increasing . obesity is a particular concern , both as a risk factor for cvd and for the development of diabetes mellitus ( dm ) and hypertension ( htn ) . obesity has reached epidemic proportions in india in the 21 century , with morbid obesity affecting 5% of the country 's population . . national family health survey ( nfhs-3 , 20052006 ) shows around 15% of women and 12% men are overweight or obese . although the proportions of obese are more in urban population , the rural population is not far behind . secondary as well as primary prevention is an essential part of primary care physician 's work in accordance with the current recommendations . the primary care physician is in a unique position of influence , which may lead to the adoption of healthy lifestyles and prevent obesity . advice from the family physician ( fp ) may prompt weight loss attempts and may encourage other health - promoting behaviors . fps awareness and diagnosis of the obese and overweight is low and may contribute to its undermanagement . there is also reluctance to treat patients without comorbidities , as there is to treat the overweight as opposed to the obese . in an era of rapidly growing prevalence of obesity , the study participants were primary care physicians of health and family welfare department , designated as medical officers ( mos ) of health , working at rural primary health centers of three districts in north karnataka . the list of primary care physicians working in rural primary health centers was obtained from the district health office . self - administered questionnaire was developed by a review of literature in the field and it was validated with five mos for scope , length , and clarity . the questionnaire comprised gps knowledge , attitudes , and practices regarding managing and preventing overweight and obesity and designed to be completed in 1015 min . the completed questionnaires were hand - checked for completeness and coded before data entry . as the primary aim of this study was to find out the knowledge , attitudes , and practices of gps ; the data was examined by simple frequency counts . the study participants were primary care physicians of health and family welfare department , designated as medical officers ( mos ) of health , working at rural primary health centers of three districts in north karnataka . the list of primary care physicians working in rural primary health centers was obtained from the district health office . self - administered questionnaire was developed by a review of literature in the field and it was validated with five mos for scope , length , and clarity . the questionnaire comprised gps knowledge , attitudes , and practices regarding managing and preventing overweight and obesity and designed to be completed in 1015 min . the completed questionnaires were hand - checked for completeness and coded before data entry . as the primary aim of this study was to find out the knowledge , attitudes , and practices of gps ; the data was examined by simple frequency counts . a total of 102 mos working in rural primary health centers participated in this survey after giving informed consent . out of 102 participants , 99 ( response rate 97.1% ) responded to question on approximate prevalence of overweight and obesity in india . only 15 participants ( 15.2% ) answered correctly , whereas , 20 ( 20.2% ) indicated as do nt know . htn , dm , and cvds were indicated as comorbidities associated with obesity by 73 ( 71.6% ) , 78 ( 76.5% ) , and 60 ( 58.8% ) participants , respectively . ischemic heart disease , osteoarthritis , sleep apnea , infertility , renal disorders , fatty liver , and cholecystitis were also indicated as comorbidities by 9 ( 8.8% ) , 21 ( 20.6%),4 ( 3.9%),5 ( 4.9% ) , 8 ( 7.8% ) , and 4 ( 3.9% ) participants , respectively ; whereas , 10 ( 9.8% ) answered  others  and 8 ( 7.8% ) were unaware of the comorbidities . out of 102 , 94 ( response rate 92.2% ) participants responded to questions on cutoff body mass index ( bmi ) value for overweight and obesity . only 25 ( 26.6% ) and 12 ( 12.8% ) participants indicated appropriate bmi cutoff values for overweight and obesity diagnosis , whereas , 32 ( 34% ) and 35 ( 37.2% ) participants had no idea about this , respectively . out of 102 participants , 54 responded that they were not aware of the guidelines for obesity management . most common treatment option for overweight / obesity was to decrease calorie intake indicated by 73 ( 71.6% ) participants followed by increased physical activity 63 ( 61.7% ) . drugs , surgery , lifestyle modification , liposuction , and yoga / stress management were mentioned by 21 ( 20.6% ) , 15 ( 14.7% ) , 12 ( 11.7% ) , 9 ( 8.8% ) , and 7 ( 6.9% ) participants , respectively . attitude section : more than half of the participants ( 57% ) agreed that obesity is a disease . most of the participants ( 90% ) felt that the adults with bmi within the healthy range should be encouraged to maintain their weight and 75% of them agreed that most overweight persons should be treated for weight loss . however , nearly half of the participants ( 48 and 45% ) felt that only obese and overweight with comorbidities should be treated for weight loss , respectively . many participants ( 75% ) agreed that small weight loss in obese / overweight can achieve major medical benefit and most of them ( 88% ) felt that doctors should maintain ideal body weight . sixty percentage of them felt that they are professionally well - trained to treat overweight / obese people . seventy percentage participants felt that overweight / obese people are generally lazier and nearly half of them ( 52% ) also felt that they lack willpower and motivation . responses to attitude section aspects many ( 67% ) of the participants use bmi to diagnose overweight / obese people whereas 12,5 , and 19 respondents also mentioned appearance , abdominal circumference , and standard weight chart , respectively . non - adherence to lifestyle modification ( 9% ) , food taboos ( 8% ) , lack of motivation ( 22% ) , lack of knowledge towards obesity ( 13% ) , and comorbidities ( 3% ) were the barriers / problems encountered in managing overweight / obese persons . majority of the participants advice their patients to increase physical activity ( 97% ) , restrict fat ( 97% ) , restrict sugar intake ( 85% ) , increase fruits and vegetable consumption ( 90% ) , reduce red meat ( 81% ) , and avoid alcohol consumption ( 90% ) . two - thirds of the participants ( 66% ) refer their patients for dietician 's advice and quarter of them ( 26% ) refers to alternative system of medicine . out of 102 participants , 99 ( response rate 97.1% ) responded to question on approximate prevalence of overweight and obesity in india . only 15 participants ( 15.2% ) answered correctly , whereas , 20 ( 20.2% ) indicated as do nt know . htn , dm , and cvds were indicated as comorbidities associated with obesity by 73 ( 71.6% ) , 78 ( 76.5% ) , and 60 ( 58.8% ) participants , respectively . ischemic heart disease , osteoarthritis , sleep apnea , infertility , renal disorders , fatty liver , and cholecystitis were also indicated as comorbidities by 9 ( 8.8% ) , 21 ( 20.6%),4 ( 3.9%),5 ( 4.9% ) , 8 ( 7.8% ) , and 4 ( 3.9% ) participants , respectively ; whereas , 10 ( 9.8% ) answered  others  and 8 ( 7.8% ) were unaware of the comorbidities . out of 102 , 94 ( response rate 92.2% ) participants responded to questions on cutoff body mass index ( bmi ) value for overweight and obesity . only 25 ( 26.6% ) and 12 ( 12.8% ) participants indicated appropriate bmi cutoff values for overweight and obesity diagnosis , whereas , 32 ( 34% ) and 35 ( 37.2% ) participants had no idea about this , respectively . out of 102 participants most common treatment option for overweight / obesity was to decrease calorie intake indicated by 73 ( 71.6% ) participants followed by increased physical activity 63 ( 61.7% ) . drugs , surgery , lifestyle modification , liposuction , and yoga / stress management were mentioned by 21 ( 20.6% ) , 15 ( 14.7% ) , 12 ( 11.7% ) , 9 ( 8.8% ) , and 7 ( 6.9% ) participants , respectively . attitude section : more than half of the participants ( 57% ) agreed that obesity is a disease . most of the participants ( 90% ) felt that the adults with bmi within the healthy range should be encouraged to maintain their weight and 75% of them agreed that most overweight persons should be treated for weight loss . however , nearly half of the participants ( 48 and 45% ) felt that only obese and overweight with comorbidities should be treated for weight loss , respectively . many participants ( 75% ) agreed that small weight loss in obese / overweight can achieve major medical benefit and most of them ( 88% ) felt that doctors should maintain ideal body weight . sixty percentage of them felt that they are professionally well - trained to treat overweight / obese people . seventy percentage participants felt that overweight / obese people are generally lazier and nearly half of them ( 52% ) also felt that they lack willpower and motivation . many ( 67% ) of the participants use bmi to diagnose overweight / obese people whereas 12,5 , and 19 respondents also mentioned appearance , abdominal circumference , and standard weight chart , respectively . non - adherence to lifestyle modification ( 9% ) , food taboos ( 8% ) , lack of motivation ( 22% ) , lack of knowledge towards obesity ( 13% ) , and comorbidities ( 3% ) were the barriers / problems encountered in managing overweight / obese persons . majority of the participants advice their patients to increase physical activity ( 97% ) , restrict fat ( 97% ) , restrict sugar intake ( 85% ) , increase fruits and vegetable consumption ( 90% ) , reduce red meat ( 81% ) , and avoid alcohol consumption ( 90% ) . two - thirds of the participants ( 66% ) refer their patients for dietician 's advice and quarter of them ( 26% ) refers to alternative system of medicine . obesity is emerging as an important health problem in india , paradoxically coexisting with undernutrition . many of the primary care physicians were unaware about the epidemiological burden of obesity and overweight in india . the rising prevalence of obesity is associated with the increasing prevalence of non communicable diseases like htn , type 2 dm ( t2 dm ) , and cvd . htn , dm , and cvds was indicated in 5875% of the participants as major comorbidities associated with obesity and only few of them ( 8% ) were unaware about these comorbidities . striking finding was majority of the participants were unaware about the cutoff values of bmi for diagnosing the person as overweight / obese . moreover half of the participants reported that they were not aware of the guidelines for obesity management ; however , many of them indicated decreasing the calorie intake and increasing physical activity as the two most common guidelines . nearly all of them felt that the adults with bmi within the healthy range should be encouraged to maintain their weight , and three - fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit . however , nearly half of the participants responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss . nearly two - thirds of them had a perception that overweight / obese are generally lazier and almost half of them felt that such individuals lack willpower and motivation . most of physicians agreed that doctors should maintain ideal body weight and slightly more than half of them felt that they are professionally competent to treat overweight / obese . previous studies in other countries have shown that gps do not appropriately evaluate and manage overweight and obesity satisfactorily . two - thirds of them use bmi to diagnose overweight / obese and nearly all of them advice their patients to increase physical activity and restrict fat . in a study , gps were advising less than one - third of obese patients to lose weight . most of the participants were advising their patients to restrict sugar intake , increase fruits and vegetable consumption , reduce red meat , and avoid alcohol consumption . interestingly , two - thirds of the participants refer their patients for dietician 's advice and quarter of them to alternative system of medicine . the present study assessed the knowledge , attitude , and practices towards obesity among primary care physicians working in rural health centers . our results clearly indicate lack of knowledge regarding epidemiological burden and about guidelines for evaluating and managing obesity among primary care physicians . though the perceptions and practices of the gps were encouraging and promising , many of the responses were stereotypical and not consistent . this study has some limitations ; we collected self - reported practices from the participants which were not validated with patient responses or outcomes , included only public sector gps . as per our knowledge , this is a first ever attempt in india in this regard . we recommend structured in - service training to primary care physicians to further improve their knowledge and practices towards management of overweight and obesity .
introduction : obesity is a risk factor for cardiovascular disease ( cvd ) , diabetes mellitus ( dm ) , and hypertension ( htn ) . in an era of rapidly growing prevalence of obesity , it is important to explore the current knowledge , attitude , and practices of primary care physicians.materials and methods : study participants were medical officers ( mos ) of primary health centers in three districts of north karnataka . 
 the questionnaire was developed by a review of literature in the field and validated with five participants for scope , length , and clarity.results/discussion:of the 102 participants , only 15% were aware about the burden of obesity in india . 
 htn , dm , and cvd were indicated as comorbidities by 73 , 78 , and 60 participants , respectively . only 25 and 12 participants indicated appropriate body mass index ( bmi ) cut - off values for overweight and obesity diagnosis . of the 102 participants , 54 were not aware of the guidelines for obesity management . 
 practices and attitudes of the participants were encouraging . 
 nearly all of them felt that the adults with bmi within the healthy range should be encouraged to maintain their weight and , three - fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit . 
 however , nearly half of the participants responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss . 
 two - thirds of them use bmi to diagnose overweight / obese and nearly all of them advice their patients to increase physical activity and restrict fat . 
 most of the participants were advising their patients to restrict sugar intake , increase fruits and vegetable consumption , reduce red meat , and avoid alcohol consumption.conclusion:present study exposed the lack of knowledge regarding obesity . 
 however , practices and attitudes of the participants were promising . 
 there is a need of in - service training to mos to further improve their knowledge and practices towards management of obesity .