Abstract
BackgroundObesity 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.MethodsThree 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.ResultsThe 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.ConclusionMany 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.
Highlights
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
Our aims were addressed by using focus groups to inform the creation and administration of a survey to primary care clinicians in the Iowa City Veteran's Affairs Medical Center (VAMC) and primary care clinicians practicing at the Bettendorf Community Based Outpatient Clinic (CBOC)
Most clinicians believed that both group appointments for obese patients (72.7%) and having patients fill out readiness to change questionnaires about obesity prior to the visit (72.7%) would be helpful
Summary
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. BMC Family Practice 2006, 7:35 http://www.biomedcentral.com/1471-2296/7/35 level 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 [7,8,9,10,11,12], perceived inability to change patient behaviors [12], lack of known effectiveness of treatments [8,13,14], negative attitudes toward obese patients [15,16,17], 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]. 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
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