ORIGINAL RESEARCH
Jodi Summers Holtrop; Johnny Williams; Elena Broaddus-Shea; Leigh Perreault; Peter C. Smith; Caroline K. Tietbohl
Corresponding Author: Jodi Summers Holtrop; Department of Family Medicine, School of Medicine; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado.
Email: Jodi.Holtrop@ucdenver.edu
DOI: 10.3122/jabfm.2025.250439R2
Keywords: Obesity, Patient Care, Perception, Primary Health Care, Psychological Models, Qualitative Research
Dates: Submitted: 11-17-2025; Revised: 02-10-2026; 02-23-2026; Accepted: 03-16-2026
Status: In Press.
INTRODUCTION: Obesity is a complex condition. Understanding how clinicians conceptualize obesity could reveal unconscious biases that may direct effective strategies to improve patient care.
METHODS: Qualitative study using applied concept mapping to identify mental models of primary care clinicians around what constitutes successful weight management and their roles in that process. We created concept maps with a purposeful sample of participants via interviews and quantitatively and qualitatively analyzed the maps.
RESULTS: Through 17 interviews, we identified three types of mental models around weight management in primary care: physiologic (n=4), biopsychosocial (n=8) and systemic (n=5). Each type differed regarding perceptions around causes of obesity primarily, but also how that impacted the clinician’s perception of their role in weight management and approach to treatment. Physiologic types viewed obesity as a metabolic issue to be addressed with diet, exercise, and coaching and rely on patients to initiate discussion. Biopsychosocial types viewed obesity as a multifaceted condition with intersecting physical, psychological, and social causes and saw their role as decision-making partners who collaborate with patients to tailor treatment. Systemic types considered obesity a larger, societal and systems structural issue, viewing themselves as resource navigators who could point patients in the right direction but who were ultimately limited by pervasive systemic barriers in society.
DISCUSSION: Primary care clinicians play an important role in providing weight management care, but differences in how clinicians conceptualize obesity may impact patient care and inform the creation of strategies to improve high quality weight management care in primary care.