title: Barriers to obesity management: a pilot study of primary care clinicians.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA. valerie-hoffman@uiowa.edu
authors.forename: Valerie
authors.initials: V
authors.lastname: Forman-Hoffman
authors.forename: Amanda
authors.initials: A
authors.lastname: Little
authors.forename: Terry
authors.initials: T
authors.lastname: Wahls
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D001291:Attitude of Health Personnel; D015992:Body Mass Index; D002983:Clinical Competence; D003376:Counseling / Q000706:statistics & numerical data; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D007484:Iowa; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000517:prevention & control*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000193:education / Q000706:statistics & numerical data*; D015431:Weight Loss