Obesity, a problem in rural areas: Challenges and proposed solutions

Neuruppin, 28 March 2024

Obesity is a serious chronic illness involving considerable health risks. Health services for obese persons are particularly problematic in rural areas. Annika Wagner and Lennart Gretschel, two doctoral candidates at the MHB center for health services research (ZVF-BB), presented their findings at the international workshop “Liberation medicine – past, present and future” hosted by the Max Planck Institute for Social Anthropology and the Martin Luther University Halle-Wittenberg, together with their mentor Dr. Stefan Reinsch, also from the ZVF-BB. Their project on obesity in rural areas originated from the contrast between the low priority given to the topic of obesity in medical studies and its tremendous social relevance, says Lennart Gretschel.

Obesity is far more than just a few kilos too many on the scale. It is a serious chronic illness and involves considerable health risks. Consequences of severe overweight are manifold and range from impaired quality of life to a markedly increased risk of secondary diseases like diabetes, cardiovascular disorders and cancer. Apart from physical limitations, obese persons often suffer from social stigma. They are excluded and discriminated, and they encounter prejudices in all spheres of life, at school, at work and in recreational activities. This kind of social exclusion may lead to feelings of shame, depression and anxiety, which further reduce their quality of life.

According to Lennart Gretschel, the prevalence of obesity in Brandenburg is among the highest in Germany: “In markedly rural regions like Oderbruch or Prignitz, general practitioners often are the only points of contact on site. We interviewed a total of 32 physicians and their patients over the past two and a half years. We want to understand the specific features of rural areas, and what health services for obese people in these circumstances could or should look like.”

Dr. Stefan Reinsch as supervisor of the project points out that obesity may be one of the most overlooked illnesses, despite its visibility and stigmatization: “The situation in the countryside, where the supply infrastructure was much thinned out after reunification and where social practices like meat-dominated eating habits have been retained, requires particular efforts to study and understand people’s life conditions.”  

Annika Wagner adds: “A side effect of our study is that it has changed not only my attitude towards obese people but also my expectations of myself. In my future work as a family doctor, I want to be open and nonjudgemental in dealing with obese patients, no matter how hard that may be. I want to offer help where help is required and give due attention to the realities of life outside the doctor’s office.”

At the workshop in Halle Annika Wagner and Lennart Gretschel presented the content of their article which addresses the living environments of physicians, patients and others in the context of conditions in the countryside, special features, cultural elements, reunification in 1990 and its implications for rural areas in the former GDR.

Waiting for the bus to the nearest hospital – Photo taken in Gnewikow near Neuruppin, 330 inhabitants.   

The question remains which measures – from their perspective and based on study results – they think are appropriate to improve healthcare provision for obese people in the country. Lennart Gretschel believes that the interaction between physician and patient is important. “But that can be difficult since they have different backgrounds. Technical terms, unclear symptoms, lack of time or emotional sensitivities can cause misunderstandings and communication problems. Efficient communication requires that physician and patient respect each other and remain open to the other person’s needs and suggestions. The doctor should use language that medical laypersons can understand, and the patient should ask questions. Both should be aware of factors influencing communication, and in case of misunderstandings treat each other with patience and sympathy.”

Summing up their impressions of the event which brought researchers and practitioners from the fields of anthropology, public health, medicine, psychotherapy and related disciplines together, Gretschel says it was quite an effort but in the end of course a fantastic experience and a chance to meet international researchers from various fields and present study results to such a large audience. Annika Wagner speaks of great feedback and interesting contacts, and deeper insights into the worlds of research and social sciences.  

Prof. Stefan Gretschel as spokesman of the Integrated Working Group "Obesity/Metabolic syndrome in an ageing society" says he is highly pleased and proud that MHB doctoral candidates gave the opening speech at a workshop of the Max Planck Institute and the University of Halle in the session on “Social causes of illness”- “a demonstration of what can be achieved at the MHB.”