From the frontlines to the world of research

After spending the early part of his career as a clinician in rural areas, Professor John Dixon has since emerged as one of Australia’s leading researchers into obesity and its associated conditions. Professor Dixon has published more than 160 peer-reviewed articles in the world’s most respected medical journals. He is known internationally for his research into obesity and its comorbid conditions, as well as weight loss treatments and their effects on health. A passionate advocate for patients, Professor Dixon is committed to raising the standards of clinical care for those dealing with obesity. Professor Dixon’s background in primary care has led to a patient-centred approach to research that incorporates a diverse look at the numerous ways obesity interacts with other chronic conditions.

Diabetes is the fastest growing chronic condition in Australia, with one new person diagnosed with the disease every five minutes. Around 1.7 million of us have diabetes, and more than 100,000 are added to that figure each year. It is estimated that diabetes costs the economy around $14 billion annually. The disease can lead to an increased risk of heart attacks and strokes, blindness, kidney failure, and depression and anxiety. Every year there are 10,000 hospital admissions in Australia for diabetes-related foot ulcers, and many of these lead to amputation of a limb. Effective management of the disease is essential to the ongoing health of diabetes patients, and GPs are often the primary source of information and care for those with the disease. Type 2 diabetes is far more common than type 1, and is associated with lifestyle risk factors such as obesity. Australians are becoming heavier, and around two-thirds of adults (and a quarter of children) are already classified as overweight or obese. As the obesity epidemic continues to spread and our population ages, type 2 diabetes is likely to affect the lives of more and more Australians. 

In 2012 Professor Dixon received a grant from the RACGP Foundation and the HCF Research Foundation that would enable him to research the experiences of severely obese type 2 diabetes patients. He wanted to compare their overall wellbeing to that of less heavy diabetes patients, understand their self-care habits and challenges, as well as learn how their healthcare experiences differed to other patients. Professor Dixon used data from the national MILES Study that surveyed more than 3300 adult diabetes patients on the psychological, behavioural, and social aspects of living with the disease. Around a third of respondents who reported their height and weight data were classified as severely obese, indicating a body mass index (BMI) score of 35 and above. The links between diabetes and obesity were already well established, but for Professor Dixon it was critical to understand the specific challenges this group of patients face in their daily lives. The co-funded grant he received from the RACGP Foundation and the HCF Research Foundation resulted in a series of academic articles that provide important insights for all general health practitioners.

What we learned: findings and implications for future healthcare

Analysis by Professor Dixon looked at the emotional wellbeing of severely obese type 2 diabetes patients, and how that related to factors such as financial disadvantage. His research found that compared to a control group, this cohort of patients are more likely to face economic and social disadvantage. They were less likely to have a current partner, paid employment, health insurance, and university or higher educational qualifications. In turn, their emotional wellbeing was significantly affected, with higher levels of depressive symptoms reported. Professor Dixon writes that, “unemployment and receiving a disability pension were most strongly associated with poor emotional wellbeing ... the current study clearly demonstrates the presence of socio-demographic and economic disadvantage in the severely obese respondents and an association with symptoms of depression”.

Further analysis revealed that while high-BMI type 2 patients reported similar self-care behaviours as other groups, they were “less likely to achieve healthy diet and exercise targets, placed less importance on diet and exercise recommendations, and found the burden of diet and exercise recommendations to be greater”. Professor Dixon’s research showed for the first time that obese individuals with type 2 diabetes think about diet, weight management, and exercise in quite different ways to those with lower BMIs. Despite heavier patients being more likely to be trying to lose weight, they were finding it significantly more difficult to do so and considered it a greater burden. In the severely obese group, just 16% were reaching exercise targets and 18% followed a healthy diet most of the time. In other areas of self care such as the monitoring of blood glucose levels, taking medications, and insulin use, there was no difference in behaviours between groups.

Professor Dixon’s research has important implications for clinical care and the specific needs of severely obese type 2 diabetes patients. Seventy per cent of all type 2 patients say a GP is their primary source of information, management advice, and support for their condition. GPs need to be aware of the challenges that severely obese patients face, and tailor their care accordingly. Through his partnership with the RACGP Foundation and the HCF Research Foundation, Professor Dixon has demonstrated the compounding emotional, psychological and lifestyle issues that need to be considered as part of their disease management. 

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