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

To the Editor: We appreciate the thoughtful comments from Fe Garcia Agana with regard to our recent article.¹ Fe Garcia Agana notes that our instrument did not assess patient income or education level as variables associated with reported willingness to participate in comprehensive weight loss programs. We agree that these patient factors are associated with risk of obesity within racial and ethnic groups, and may be important in predicting reported willingness to participate in comprehensive weight loss programs. We also acknowledge that offering the questionnaire only in written format may have limited or favored participation for certain groups.

In our project, we used a card study methodology, an established method for collecting observational data in practice-based research networks.² Card studies are, by definition, brief and limited in scope.² Our study was developed and conducted using participatory methods.³ Thus, the method of administration and selected list of variables were chosen by the participating primary care practice champions to maximize simplicity during administration and minimize impact on clinical workflow. Finally, we considered excluding overweight and nearly overweight adults from our response sample, but sensitivity analysis without their responses found no changes in our primary outcomes; thus we chose to leave them in the sample.