Obesity counseling and guidelines in primary care: a qualitative study.
BACKGROUND
The problem of obesity is now epidemic in the United States. Despite the existence of clinical guidelines for prevention and treatment of obesity and documented clinician concern about this problem, counseling for obesity reduction in primary care is infrequent. The principal aim of this study was to examine the views of clinicians on obesity counseling and to compare these views to the recommendations of leading obesity guidelines.


METHODS
Twenty individual, in-depth interviews and two focus groups of clinicians serving predominantly low-income minority populations were conducted in a practice-based research network. Data were analyzed using immersion/crystallization and template approaches.


RESULTS
Clinicians believe obesity is an important problem and report using mostly brief, targeted, low-intensity counseling in the face of limited patient motivation and lack of resources to support weight loss. They view family, cultural, social, and community factors as central to the problem of obesity, and their own efforts as generally ineffective. These clinicians similarly were unconvinced of the long-term effectiveness of any weight-loss strategies.


CONCLUSIONS
Low levels of obesity counseling in primary care may reflect clinicians' self-assessment of their ineffectiveness in this area rather than lack of interest or knowledge. These clinicians perceive that obesity control efforts aimed at local community factors and environmental modifications are key strategies in augmenting and linking their efforts to successful outcomes.
Leverence
Robert R
RR
Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico 87131, USA. rleverence@salud.unm.edu
Williams
Robert L
RL
Sussman
Andrew
A
Crabtree
Benjamin F
BF
D003376:Counseling; D005260:Female; D017144:Focus Groups; D017408:Guidelines as Topic; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009765:Obesity / Q000175:diagnosis; D011320:Primary Health Care; D014481:United States