Methods: Email invitation with a survey link was sent to 124 primary care providers in the Department of Medicine at UCLA Health. A second reminder was sent after two weeks. The survey was titled “Barriers to Treating and Managing Obesity” and was administered through SurveyMonkey for a total of four weeks. The results were summarized and shared with all primary care providers with information on the organization’s obesity management pathway that is based on the latest national evidence-based guidelines as well as an invitation to attend an upcoming wellness seminar to learn about obesity management.
Results: Thirty-six (29%) primary care providers responded to the survey. The participants listed the following major barriers to weight loss counseling: time (30, 83.33%), patient's lack of motivation (25, 69.44%), inadequate training (14, 38.89%), reimbursement (11, 30.56%), and uncomfortable nature of the subject (8, 22.22%). The interventions that were perceived as being done frequently or always included: counseling patients about behavioral interventions for weight loss such as goal setting, dietary changes, exercise habits or self-monitoring (33, 91.67%), discussion of patient’s weight (32, 88.89%), use of motivational interviewing techniques to help patients with weight loss (22, 61.11%), and referring patients to nutritional counseling for weight loss (20, 55.55%). The interventions that were perceived as being done rarely or never included: prescribing weight loss medications (31, 86.11%), referring patients for behavioral counseling for weight loss (19, 52.78), and referring patients to bariatric surgery (23, 68.89%). All the survey participants (100%) said they would be interested in referring patients with body mass index of 30 or more for a weight management program.
In addition to the above, participants had the option to share comments and feedback on current programs and other barriers. Typical comments were: “I wish we had more resources for behavioral counseling for weight loss”; “There needs a multidisciplinary focus on this serious issue including access to nutritionist, exercise/physical activity and physician time”; “It would be helpful to have a clear set of guidelines regarding what services patients are eligible for - for example, medical weight management referrals are often declined. It would also be useful to be able to refer patients to commercial or other programs in their communities (at low cost for patients). Getting insurance buy-in and having a resource list with stats on the effectiveness of different programs would be helpful.”
Conclusion: Obesity is a major public health problem and cause of mortality worldwide. Many clinical guidelines on diagnosing, treating, and managing obesity have been recently published. However, major barriers exist in treating and managing patients. This study has identified some reasons why primary care providers have difficulty in addressing obesity with their patients. The barriers identified in practice are many, suggesting that interdisciplinary approaches are needed to bridge evidence and best practice and improve outcomes for patients.