Article Figures & Data
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Clinician Interviews (n = 20) Focus Groups (n = 10) Network Survey (n = 146) Gender Female 9 4 77 Practice specialty Family physicians 5 5 83 Pediatricians 5 2 32 Mid-level practitioners (PA, NP) 7 2 18 Internists 3 1 13 Totals 20 10 146 Institutional setting University of New Mexico 9 4 54 Community Health Center 6 4 35 Indian Health Service 5 2 51 Private practice 0 0 6 Totals 20 10 146 PA, physician assistant; NP, nurse practitioner.
Rank (%) (n = 146) 1. Obesity can be viewed in a number of ways. Please rank the following statements in order according to how you view the problem of obesity. 1st 2nd 3rd Obesity is best viewed as a disease, disorder, or illness amenable to medical intervention. 6 14 80 Obesity is best viewed as a more general syndrome, the result of complex interactions between heredity and the physical environment. 68 26 6 Obesity is best viewed as a matter of personal health and wellness, for which choices are strongly influenced by the emotional and relational domains of health. 28 58 14 2. The approach to obesity can also be viewed in a number of ways. Please rank the following statements in order according to how you view solutions to the problem of obesity. Biomedical or technical advances (such as a pill) will ultimately offer the greatest benefit for prevention and treatment of obesity. 4 11 85 Although genetic and molecular research may hold promise, efforts addressing environmental and socioeconomic factors will have the greatest benefit for prevention and treatment of obesity. 58 37 5 Approaches favoring personal health and wellness will have the greatest benefit for prevention and treatment of obesity. 41 50 9 3. Under what conditions or for which patients do you discuss obesity? Check all that apply. % (n = 146) All visits. 21 All well-child checks or annual exams. 60 Patients at risk for obesity or diabetes. 90 Teachable Moments–when presented with a condition affected by their obesity. 94 When a patient or family member wishes to discuss it. 88 I rarely discuss it. 0 Other. 5 4. Compared with other issues in the clinical encounter, I may choose not to spend time on counseling about obesity because: Location of mark on visual analogue scale, where strongly disagree = 0 and strongly agree = 100, mean (SD) (n = 143) Patients are not receptive to discussing this topic 41.2 (24.2) I don't feel it is time well spent. 23.0 (23.4) I don't have much success with this. 50.0 (24.4) It is a societal problem that my efforts have little impact on. 30.0 (24.8) Few patients are motivated to make the lifestyle changes needed. 48.0 (23.4) There isn't enough time. 52.6 (24.4) I don't feel like I have the skills or knowledge needed to be effective in this area. 28.9 (22.5) My patients generally do not have the personal or community resources to be able to deal with this. 48.1 (26.9) 5. I spend time on counseling about obesity because: Location of mark on visual analogue scale, where strongly disagree = 0 and strongly agree = 100, mean (SD) (n = 142) I have had some success with this in the past. 54.4 (21.3) It is recommended by clinical guidelines. 59.0 (22.7) My patients are unlikely to hear a similar message elsewhere. 52.5 (26.9) Interactions with my colleagues have influenced me to do so. 36.8 (22.7) Because of my personal belief that the nonobese have a significantly better quality of life. 69.6 (25.2) 6. Which of the following is most important in your decision to spend time counseling about obesity. % (n = 135) I have had some success with this in the past. 12 It is recommended by clinical guidelines. 12 My patients are unlikely to hear a similar message elsewhere. 10 Interactions with my colleagues have influenced me to do so. 2 Because of my personal belief that the nonobese have a significantly better quality of life. 64 7. In treating obese patients, I consider a successful outcome to be (please choose one): % (n = 138) The patient must lose sufficient weight to have a BMI under 30. 1 The patient should progressively decrease weight, if only in small amounts. 38 A total weight loss of 5 to 10 lbs. 4 No additional weight gain. 10 Any positive change in health habits, even if there continues to be a slight increase in weight. 43 Other. 4 Location of mark on visual analogue scale, where strongly disagree = 0 and strongly agree = 100, mean (SD) 8. More time in my schedule would allow me to have a meaningful impact on obesity in my practice: 51.4 (23.1) (n = 142) 9. More clinic resources (e.g., dieticians or promotoras) would allow me to have a meaningful impact on obesity in my practice: 74.2 (22.1) (n = 140) 10. Counseling regarding obesity is important in my practice: 74.4 (18.6) (n = 142) 11. Compared with other issues I must take care of in the brief clinical encounter, I give counseling regarding obesity a high priority: 65.0 (20.1) (n = 142) Rank (%) (n = 143) 12. Please rank the following statements, according to which is likely to have the most influence on the prevention of obesity: 1st 2nd 3rd Improvement of my counseling skills. 10 24 66 Enhancement of clinic support services (e.g., dieticians or promotoras). 39 52 8 Join advocacy efforts aimed at legislation, communities, and schools. 56 20 24 13. Do you currently participate in community outreach, advocacy or legislative efforts regarding obesity % (n = 145) Yes 21 How likely are you to devote time to these types of activities if a coordinated program were available in your local or regional healthcare community? % Not likely at all. 17 Somewhat likely. 64 Very likely. 18 14. The following would be useful to me in trying to increase my effectiveness in counseling for obesity prevention and treatment: Location of mark on visual analogue scale, where strongly disagree = 0 and strongly agree = 100, mean (SD) Education for counseling on specific diets. 57.3 (27.1) (n = 138) Training on brief motivational counseling to increase my ability to help patients become ready to make lifestyle changes. 69.7 (21.8) (n = 140) 15. Based on our interviews with clinicians around the state, we have identified several considerations that are important to providers in making the decision about whether to spend time on counseling for obesity prevention in the brief clinical encounter. Please review this list and indicate in order of priority which of these is generally most important for you in determining whether to spend time with a patient on this topic. (1 = most important, etc.) Mean (SE) Rank (n = 142) % 1st 2nd 3rd 4th 5th 6th 7th Acute vs. well-care visit. 3.8 (0.16) 17 12 14 18 17 14 9 Patient agenda. 2.7 (0.13) 26 23 25 12 7 3 4 Presence/absence of teachable moment. 2.9 (0.12) 19 24 24 10 10 2 2 Perceived receptivity of patient to discussion. 3.0 (0.12) 18 22 21 21 12 4 0 Whether the patient is pediatric or adult. 5.8 (0.12) 2 1 2 8 13 36 37 Recent experiences I have had dealing with this topic. 5.7 (0.12) 2 3 4 6 18 34 34 My views about what would be best for this patient's overall health and well-being. 3.6 (0.16) 18 17 11 16 23 7 8
