title: Walking and neighborhood environments for obese and overweight patients: perspectives from family physicians.
abstract: OBJECTIVE
  Primary care practitioners can play a significant role in helping patients adopt healthy behaviors such as physical activity (PA). The aim of this qualitative study was to assess family physicians' understanding and perception of the personal and environmental factors influencing PA, especially walking, and factors affecting their counseling of obese patients about environmental motivators and barriers to PA.
  
  
  METHODS
  We conducted five focus groups with 35 family physicians and 14 family medicine residents in four clinics and a residency program affiliated with CenTexNet, a primary care practice-based research network in central Texas. Data were transcribed and analyzed using thematic content analysis.
  
  
  RESULTS
  Physicians were aware of the PA guidelines, but not many actually brought up PA during their counseling of patients. Physicians agreed that neighborhood environments are important for walking and reported that their patients often brought up environmental barriers. Physicians recommended walking as an ideal type of PA for obese patients and sidewalks, parks, and trails/tracks with smooth and soft surfaces as ideal places to engage in walking. However, they rarely talked about these factors with their patients due to a perceived ineffectiveness in counseling, an inability to address environmental factors, and time constraints in the medical encounter.
  
  
  CONCLUSIONS
  While physicians believe neighborhood environments often present many barriers to PA, they still believe that environmental factors are secondary to personal motivation in promoting PA among obese patients. Physicians, if better informed of the growing evidence on the environment-PA links, may be able to facilitate patients' behavior change more effectively.
authors.affiliation: Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, School of Rural Public Health, College Station, TX 77843-1266, USA. yhong@srph.tamhsc.edu
authors.forename: Yan
authors.initials: Y
authors.lastname: Hong
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
authors.forename: Chanam
authors.initials: C
authors.lastname: Lee
authors.forename: Suojin
authors.initials: S
authors.lastname: Wang
authors.forename: Jairus
authors.initials: J
authors.lastname: Pulczinksi
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Forjuoh
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D017408:Guidelines as Topic; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control / Q000628:therapy*; D050177:Overweight / Q000628:therapy; D010821:Physicians, Family; D036301:Qualitative Research; D012111:Residence Characteristics; D016138:Walking / Q000502:physiology