Barriers to obesity management: a pilot study of primary care clinicians

BMC Family Practice, Jun 2006

Background Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings. Methods Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and an affiliated Community Based Outpatient Center (CBOC) were conducted to identify potential barriers to obesity management. The focus groups and previously published studies then informed the creation of a 47-item survey that was then disseminated and completed by 55 primary care clinicians. Results The focus groups identified provider, system, and patient barriers to obesity care. Lack of obesity training during medical school and residency was associated with lower rates of discussing diet and exercise with obese patients (p < 0.05). Clinicians who watched their own diets vigorously were more likely to calculate BMI for obese patients than other clinicians (42% vs. 13%, p < 0.05). Many barriers identified in previous studies (e.g., attitudes toward obese patients, lack of insurance payments for obesity care) were not prevalent barriers in the current study. Conclusion Many VHA clinicians do not routinely provide weight management services for obese patients. The most prevalent barriers to obesity care were poor education during medical school and residency and the lack of information provided by the VHA to both clinicians and patients about available weight management services.

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Barriers to obesity management: a pilot study of primary care clinicians

BMC Family Practice Barriers to obesity management: a pilot study of primary care clinicians Valerie Forman-Hoffman 1 2 Amanda Little 0 Terry Wahls 1 2 0 Carver College of Medicine, University of Iowa , Iowa City, IA , USA 1 Department of Internal Medicine, Carver College of Medicine, University of Iowa , Iowa City, IA , USA 2 Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) Iowa City Veterans Affairs Medical Center , Iowa City, IA , USA Background: Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings. Methods: Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and an affiliated Community Based Outpatient Center (CBOC) were conducted to identify potential barriers to obesity management. The focus groups and previously published studies then informed the creation of a 47-item survey that was then disseminated and completed by 55 primary care clinicians. Results: The focus groups identified provider, system, and patient barriers to obesity care. Lack of obesity training during medical school and residency was associated with lower rates of discussing diet and exercise with obese patients (p < 0.05). Clinicians who watched their own diets vigorously were more likely to calculate BMI for obese patients than other clinicians (42% vs. 13%, p < 0.05). Many barriers identified in previous studies (e.g., attitudes toward obese patients, lack of insurance payments for obesity care) were not prevalent barriers in the current study. Conclusion: Many VHA clinicians do not routinely provide weight management services for obese patients. The most prevalent barriers to obesity care were poor education during medical school and residency and the lack of information provided by the VHA to both clinicians and patients about available weight management services. - Background Obesity is an increasing epidemic in both the general US population [1] and veterans [2] and is an important etiologic factor in heart disease, diabetes, arthritis, depression, and various types of cancers [3,4]. It is estimated that among the 6 million users of Veterans Health Administration (VHA) services, 44% are overweight and an additional 25% are obese [5]. Although the U.S. Veterans Health Administration (VHA) is the largest integrated health care system in the United States [6], obesity in this setting has remained vastly understudied. Despite numerous studies that have defined optimal body mass index (BMI) targets for patients, numerous providerlevel barriers exist to the effective management of obesity in primary care. These barriers include lack of formal training of primary care practitioners in nutrition, obesity, and counseling on weight-related topics [7-12], perceived inability to change patient behaviors [12], lack of known effectiveness of treatments [8,13,14], negative attitudes toward obese patients [15-17], beliefs that patients are not interested or ready for treatment [9,12,19,20], and beliefs that obesity is the responsibility of the patient [21]. In addition, even though previous research has determined that patients have more confidence in weight counseling made by nonobese physicians, vegetarians, and those who used to be obese [20] and that nurse's weight impacts attitudes towards obesity and its treatment [19], it is unclear how provider's personal weight and exercise practices influence their obesity-related patient practices. Even when providers do initiate health education and dietary counseling, there is still some controversy over whether these practices actually motivate patient behavior. Although previous studies have determined that the contextual framing of health behavior counseling in a positive (i.e., emphasizing the benefits of weight loss) versus negative (i.e., emphasizing the detriments of remaining obese) manner affects patient's receptivity [22,23], it is unknown whether framing style has an impact on the successful implementation of weight-related recommendations. Nonetheless, the manner by which clinicians discuss obesity with patients does affect patients' receptiveness to counseling [16], and even modest reductions in weight can lead to significant health benefits [24,25]. For example, it is estimated that a 10% reduction in weight can extend life expectancy an average of 27 months and can reduce lifetime medical expenditures of associated chronic conditions (e.g., heart disease, diabetes) by $2200$5300 [26]. In addition to provider-related barriers, several previous studies have identified system-level barriers to obesity care. These include lack of payment by insurance companies for weight-related counseling and care [12,13,17], lack of time during patient visits [9,12,13], lack of available teaching m (...truncated)


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Valerie Forman-Hoffman, Amanda Little, Terry Wahls. Barriers to obesity management: a pilot study of primary care clinicians, BMC Family Practice, 2006, pp. 35, 7, DOI: 10.1186/1471-2296-7-35