Table 4 Beliefs about Obesity and Weight Loss, Barriers to Care, and Usefulness of Additional Weight Management Services
From: Barriers to obesity management: a pilot study of primary care clinicians
| Â | Mean (sd)1 | n (%) | Â |
|---|---|---|---|
Provider Level Barriers | Â | Â | Â |
Most obese patients are not ready to do anything about their weight | 3.1 (0.9) | 0 | Strongly Disagree |
| Â | Â | 16 (29.1) | Disagree |
| Â | Â | 21 (38.2) | Neutral |
| Â | Â | 14 (25.5) | Agree |
| Â | Â | 4 (7.3) | Strongly Agree |
There is no evidence that physician-deliveredweight management counseling is effective | 2.5 (0.8) | 5 (9.1) | Strongly Disagree |
| Â | Â | 25 (45.5) | Disagree |
| Â | Â | 20 (36.4) | Neutral |
| Â | Â | 5 (9.1) | Agree |
| Â | Â | 0 | Strongly Agree |
There are no effective treatments for obesity | 2.1 (0.8) | 8 (14.5) | Strongly Disagree |
| Â | Â | 38 (69.1) | Disagree |
| Â | Â | 6 (10.9) | Neutral |
| Â | Â | 2 (3.6) | Agree |
| Â | Â | 1 (1.8) | Strongly Agree |
I learned good obesity management practices in medical school | 2.8 (1.0) | 5 (9.1) | Strongly Disagree |
| Â | Â | 17 (30.9) | Disagree |
| Â | Â | 20 (36.4) | Neutral |
| Â | Â | 12 (21.8) | Agree |
| Â | Â | 1 (1.8) | Strongly Agree |
I learned good obesity management practices during residency training | 2.9 (1.0) | 5 (9.1) | Strongly Disagree |
| Â | Â | 15 (27.3) | Disagree |
| Â | Â | 18 (32.7) | Neutral |
| Â | Â | 15 (27.3) | Agree |
| Â | Â | 2 (3.6) | Strongly Agree |
I sometimes do not address obesity in fear of "ruining the relationship" | 2.0 (0.8) | 14 (25.5) | Strongly Disagree |
| Â | Â | 29 (52.7) | Disagree |
| Â | Â | 8 (14.5) | Neutral |
| Â | Â | 4 (7.3) 0 | Agree Strongly Agree |
System-Level Barriers | Â | Â | Â |
I need more education about weight management services offered by the VA | 4.1 (0.5) | 0 | Strongly Disagree |
| Â | Â | 0 | Disagree |
| Â | Â | 3 (5.6) | Neutral |
| Â | Â | 41 (75.9) | Agree |
| Â | Â | 10 (18.5) | Strongly Agree |
The VA needs more comprehensive weight management services | 3.9 (0.6) | 0 | Strongly Disagree |
| Â | Â | 2 (3.6) | Disagree |
| Â | Â | 7 (12.7) | Neutral |
| Â | Â | 39 (70.9) | Agree |
| Â | Â | 7 (12.7) | Strongly Agree |
The VA needs to make obesity a higher priority | 3.8 (0.8) | 0 | Strongly Disagree |
| Â | Â | 4 (7.3) | Disagree |
| Â | Â | 9 (16.4) | Neutral |
| Â | Â | 35 (63.6) | Agree |
| Â | Â | 7 (12.7) | Strongly Agree |
I would be more likely to address obesity with patients if visit times were longer | 3.5 (1.0) | 3 (5.5) | Strongly Disagree |
| Â | Â | 6 (10.9) | Disagree |
| Â | Â | 12 (21.8) | Neutral |
| Â | Â | 28 (50.9) | Agree |
| Â | Â | 6 (10.9) | Strongly Agree |
Lack of payment by insurers hinders my weight management practices in VA primary care | 2.8 (1.0) | 5 (9.1) | Strongly |
| Â | Â | 16 (29.1) | Disagree |
| Â | Â | 19 (34.5) | Neutral |
| Â | Â | 19 (27.3) | Agree |
| Â | Â | 0 | Strongly Agree |
Beliefs about Obesity and Weight Loss | Â | Â | Â |
Obesity is a very important public health problem | 4.8 (0.5) | 0 | Strongly Disagree |
| Â | Â | 0 | Disagree |
| Â | Â | 1 (1.8) | Neutral |
| Â | Â | 9 (16.4) | Agree |
| Â | Â | 45 (81.8) | Strongly Agree |
Obesity is difficult to treat | 4.4 (0.6) | 0 | Strongly Disagree |
| Â | Â | 0 | Disagree |
| Â | Â | 2 (3.6) | Neutral |
| Â | Â | 27 (49.1) | Agree |
| Â | Â | 26 (47.3) | Strongly Agree |
Obesity is a disease | 4.2 (0.9) | 1 (1.8) | Strongly Disagree |
| Â | Â | 1 (1.8) | Disagree |
| Â | Â | 6 (10.9) | Neutral |
| Â | Â | 23 (41.8) | Agree |
| Â | Â | 24 (43.6) | Strongly Agree |
I am more likely to address obesity if the patient is younger | 3.0 (1.0) | 1 (1.8) | Strongly Disagree |
| Â | Â | 22 (40.0) | Disagree |
| Â | Â | 14 (25.5) | Neutral |
| Â | Â | 15 (27.3) | Agree |
| Â | Â | 3 (5.5) | Strongly Agree |
Most VA patients attribute their obesity to an external cause (e.g., agent orange) rather than an internal cause (e.g., their lack of self discipline | 2.6 (0.8) | 1 (1.8) | Strongly Disagree |
| Â | Â | 27 (49.1) | Disagree |
| Â | Â | 19 (34.5) | Neutral |
| Â | Â | 5 (9.1) | Agree |
| Â | Â | 2 (3.6) | Strongly Agree |
Having multiple comorbidities (e.g., diabetes, hypertension, osteoarthritis) makes it less likely that I will address obesity | 1.9 (1.1) | 26 (47.3) | Strongly Disagree |
| Â | Â | 19 (34.5) | Disagree |
| Â | Â | 3 (5.5) | Neutral |
| Â | Â | 6 (10.9) | Agree |
| Â | Â | 1 (1.8) | Strongly Agree |
Usefulness of Additional Services | Â | Â | Â |
The VA needs to develop educational materials about weight management to pass out to patients | 4.1 (0.6) | 0 | Strongly Disagree |
| Â | Â | 1 (1.8) | Disagree |
| Â | Â | 4 (7.3) | Neutral |
| Â | Â | 39 (70.9) | Agree |
| Â | Â | 11 (20.0) | Strongly Agree |
Having an obesity educator in the VA would be helpful | 4.1 (0.8) | 1 (1.8) | Strongly Disagree |
| Â | Â | 1 (1.8) 5 (9.1) | Disagree Neutral |
| Â | Â | 33 (60.0) | Agree |
| Â | Â | 15 (27.3) | Strongly Agree |
Having a referral box for a dietician on CPRS would be helpful | 4.0 (0.8) | 2 (3.6) | Strongly Disagree |
| Â | Â | 0 | Disagree |
| Â | Â | 6 (10.9) | Neutral |
| Â | Â | 38 (69.1) | Agree |
| Â | Â | 9 (16.4) | Strongly Agree |
Having a referral box for a physical therapist on CPRS would be helpful | 3.9 (0.8) | 2 (3.6) | Strongly Disagree |
| Â | Â | 0 | Disagree |
| Â | Â | 8 (14.5) | Neutral |
| Â | Â | 39 (70.9) | Agree |
| Â | Â | 6 (10.9) | Strongly Agree |
Having a referral box for a behavioral counselor on CPRS would be helpful | 3.9 (0.8) | 2 (3.6) | Strongly Disagree |
| Â | Â | 1 (1.8) | Disagree |
| Â | Â | 6 (10.9) | Neutral |
| Â | Â | 39 (70.9) | Agree |
| Â | Â | 7 (12.7) | Strongly Agree |
Group appointments for obesity (e.g., nutrition class, exercise class, behavior change class) would be helpful | 3.9 (0.9) | 1 (1.8) | Strongly Disagree |
| Â | Â | 4 (7.3) | Disagree |
| Â | Â | 10 (18.2) | Neutral |
| Â | Â | 26 (47.3) | Agree |
| Â | Â | 14 (25.5) | Strongly Agree |
Having patients fill out a readiness to change questionnaire about obesity prior to the visit would be helpful | 3.7 (0.9) | 2 (3.6) | Strongly Disagree |
| Â | Â | 3 (5.5) | Disagree |
| Â | Â | 10 (18.2) | Neutral |
| Â | Â | 35 (63.6) | Agree |
| Â | Â | 5 (9.1) | Strongly Agree |
The VA should give monetary incentives for weight loss (e.g. cash, reduction of copays, free obesity-related services) | 3.1 (1.3) | 8 (14.8) | Strongly Disagree |
| Â | Â | 12 (22.2) | Disagree |
| Â | Â | 10 (18.5) | Neutral |
| Â | Â | 15 (27.8) | Agree |
| Â | Â | 9 (16.7) | Strongly Agree |
If weight loss drugs were on formulary, I would prescribe them more frequently | 2.7 (1.0) | 7 (12.7) | Strongly Disagree |
| Â | Â | 18 (32.7) | Disagree |
| Â | Â | 16 (29.1) | Neutral |
| Â | Â | 14 (25.5) | Agree |
| Â | Â | 0 | Strongly Agree |