Re: Primary Care Patients' Willingness to Participate in Comprehensive Weight Loss Programs: From the WWAMI Region Practice and Research Network

To the Editor: The article by Cole et al¹ about primary care patients' willingness to participate in comprehensive weight loss programs is progressive in addressing a major health problem, yet some areas need improvement. One objective of this study was to determine patient characteristics associated with willingness to participate in these programs. The investigators failed to include 2 important factors in their survey: income and educational level. According to the Centers for Disease Control and Prevention, (1) among Mexican American and non-Hispanic black men, those with higher incomes are more likely to be obese than those with lower incomes, (2) women with higher incomes are less likely to be obese than women with lower incomes, and (3) women with college degrees are less likely to be obese than women with lower educational levels.²

Another issue is the single delivery method of the survey, that is, article format. Investigators may have lost a population of patients who may not be able to read or write well (eg, less educated people, older adults) as a result of the lack of assistance in reading the survey. They also may have lost those who are more technologically advanced. Also, clinical staff offered the surveys to patients, which may have made patients feel obliged to take the survey. Some patients may have felt that the quality of their clinical care would be affected by not participating in the clinic-offered survey.

Next, the investigators aimed to identify potential facilitators and barriers to participation in comprehensive weight loss programs, but identified only the facilitators. They asked patients to mark the top 3 of 8 listed potential factors, yet these factors were all positive and did not identify barriers to participation.

In the discussion, the investigators explained that the Patient Protection and Affordable Care Act requires insurance companies to provide coverage for obesity treatment. This study included participants who were overweight, obese, and extremely obese. Yet, the sample included participants who were considered “at risk” but not obese. Therefore, this group should be excluded from the analysis in order for the results to pertain to patients who qualify for obesity treatment.

While this article was an advancement in the understanding of primary care patients' willingness to participate in comprehensive weight loss programs, all associated factors in the health outcomes were not assessed. These factors are necessary to tailor parsimonious and appropriate comprehensive weight loss programs for primary care patients.