Table 4.
Beliefs about Obesity and Weight Loss, Barriers to Care, and Usefulness of Additional Weight Management Services
| Mean (sd)1 | n (%) | ||
| Provider Level Barriers | |||
| Most obese patients are not ready to do anything about their weight | 3.1 (0.9) | 0 | Strongly Disagree |
| 16 (29.1) | Disagree | ||
| 21 (38.2) | Neutral | ||
| 14 (25.5) | Agree | ||
| 4 (7.3) | Strongly Agree | ||
| There is no evidence that physician-deliveredweight management counseling is effective | 2.5 (0.8) | 5 (9.1) | Strongly Disagree |
| 25 (45.5) | Disagree | ||
| 20 (36.4) | Neutral | ||
| 5 (9.1) | Agree | ||
| 0 | Strongly Agree | ||
| There are no effective treatments for obesity | 2.1 (0.8) | 8 (14.5) | Strongly Disagree |
| 38 (69.1) | Disagree | ||
| 6 (10.9) | Neutral | ||
| 2 (3.6) | Agree | ||
| 1 (1.8) | Strongly Agree | ||
| I learned good obesity management practices in medical school | 2.8 (1.0) | 5 (9.1) | Strongly Disagree |
| 17 (30.9) | Disagree | ||
| 20 (36.4) | Neutral | ||
| 12 (21.8) | Agree | ||
| 1 (1.8) | Strongly Agree | ||
| I learned good obesity management practices during residency training | 2.9 (1.0) | 5 (9.1) | Strongly Disagree |
| 15 (27.3) | Disagree | ||
| 18 (32.7) | Neutral | ||
| 15 (27.3) | Agree | ||
| 2 (3.6) | Strongly Agree | ||
| I sometimes do not address obesity in fear of "ruining the relationship" | 2.0 (0.8) | 14 (25.5) | Strongly Disagree |
| 29 (52.7) | Disagree | ||
| 8 (14.5) | Neutral | ||
| 4 (7.3) 0 | Agree Strongly Agree | ||
| System-Level Barriers | |||
| I need more education about weight management services offered by the VA | 4.1 (0.5) | 0 | Strongly Disagree |
| 0 | Disagree | ||
| 3 (5.6) | Neutral | ||
| 41 (75.9) | Agree | ||
| 10 (18.5) | Strongly Agree | ||
| The VA needs more comprehensive weight management services | 3.9 (0.6) | 0 | Strongly Disagree |
| 2 (3.6) | Disagree | ||
| 7 (12.7) | Neutral | ||
| 39 (70.9) | Agree | ||
| 7 (12.7) | Strongly Agree | ||
| The VA needs to make obesity a higher priority | 3.8 (0.8) | 0 | Strongly Disagree |
| 4 (7.3) | Disagree | ||
| 9 (16.4) | Neutral | ||
| 35 (63.6) | Agree | ||
| 7 (12.7) | Strongly Agree | ||
| I would be more likely to address obesity with patients if visit times were longer | 3.5 (1.0) | 3 (5.5) | Strongly Disagree |
| 6 (10.9) | Disagree | ||
| 12 (21.8) | Neutral | ||
| 28 (50.9) | Agree | ||
| 6 (10.9) | Strongly Agree | ||
| Lack of payment by insurers hinders my weight management practices in VA primary care | 2.8 (1.0) | 5 (9.1) | Strongly |
| 16 (29.1) | Disagree | ||
| 19 (34.5) | Neutral | ||
| 19 (27.3) | Agree | ||
| 0 | Strongly Agree | ||
| Beliefs about Obesity and Weight Loss | |||
| Obesity is a very important public health problem | 4.8 (0.5) | 0 | Strongly Disagree |
| 0 | Disagree | ||
| 1 (1.8) | Neutral | ||
| 9 (16.4) | Agree | ||
| 45 (81.8) | Strongly Agree | ||
| Obesity is difficult to treat | 4.4 (0.6) | 0 | Strongly Disagree |
| 0 | Disagree | ||
| 2 (3.6) | Neutral | ||
| 27 (49.1) | Agree | ||
| 26 (47.3) | Strongly Agree | ||
| Obesity is a disease | 4.2 (0.9) | 1 (1.8) | Strongly Disagree |
| 1 (1.8) | Disagree | ||
| 6 (10.9) | Neutral | ||
| 23 (41.8) | Agree | ||
| 24 (43.6) | Strongly Agree | ||
| I am more likely to address obesity if the patient is younger | 3.0 (1.0) | 1 (1.8) | Strongly Disagree |
| 22 (40.0) | Disagree | ||
| 14 (25.5) | Neutral | ||
| 15 (27.3) | Agree | ||
| 3 (5.5) | Strongly Agree | ||
| Most VA patients attribute their obesity to an external cause (e.g., agent orange) rather than an internal cause (e.g., their lack of self discipline | 2.6 (0.8) | 1 (1.8) | Strongly Disagree |
| 27 (49.1) | Disagree | ||
| 19 (34.5) | Neutral | ||
| 5 (9.1) | Agree | ||
| 2 (3.6) | Strongly Agree | ||
| Having multiple comorbidities (e.g., diabetes, hypertension, osteoarthritis) makes it less likely that I will address obesity | 1.9 (1.1) | 26 (47.3) | Strongly Disagree |
| 19 (34.5) | Disagree | ||
| 3 (5.5) | Neutral | ||
| 6 (10.9) | Agree | ||
| 1 (1.8) | Strongly Agree | ||
| Usefulness of Additional Services | |||
| The VA needs to develop educational materials about weight management to pass out to patients | 4.1 (0.6) | 0 | Strongly Disagree |
| 1 (1.8) | Disagree | ||
| 4 (7.3) | Neutral | ||
| 39 (70.9) | Agree | ||
| 11 (20.0) | Strongly Agree | ||
| Having an obesity educator in the VA would be helpful | 4.1 (0.8) | 1 (1.8) | Strongly Disagree |
| 1 (1.8) 5 (9.1) | Disagree Neutral | ||
| 33 (60.0) | Agree | ||
| 15 (27.3) | Strongly Agree | ||
| Having a referral box for a dietician on CPRS would be helpful | 4.0 (0.8) | 2 (3.6) | Strongly Disagree |
| 0 | Disagree | ||
| 6 (10.9) | Neutral | ||
| 38 (69.1) | Agree | ||
| 9 (16.4) | Strongly Agree | ||
| Having a referral box for a physical therapist on CPRS would be helpful | 3.9 (0.8) | 2 (3.6) | Strongly Disagree |
| 0 | Disagree | ||
| 8 (14.5) | Neutral | ||
| 39 (70.9) | Agree | ||
| 6 (10.9) | Strongly Agree | ||
| Having a referral box for a behavioral counselor on CPRS would be helpful | 3.9 (0.8) | 2 (3.6) | Strongly Disagree |
| 1 (1.8) | Disagree | ||
| 6 (10.9) | Neutral | ||
| 39 (70.9) | Agree | ||
| 7 (12.7) | Strongly Agree | ||
| Group appointments for obesity (e.g., nutrition class, exercise class, behavior change class) would be helpful | 3.9 (0.9) | 1 (1.8) | Strongly Disagree |
| 4 (7.3) | Disagree | ||
| 10 (18.2) | Neutral | ||
| 26 (47.3) | Agree | ||
| 14 (25.5) | Strongly Agree | ||
| Having patients fill out a readiness to change questionnaire about obesity prior to the visit would be helpful | 3.7 (0.9) | 2 (3.6) | Strongly Disagree |
| 3 (5.5) | Disagree | ||
| 10 (18.2) | Neutral | ||
| 35 (63.6) | Agree | ||
| 5 (9.1) | Strongly Agree | ||
| The VA should give monetary incentives for weight loss (e.g. cash, reduction of copays, free obesity-related services) | 3.1 (1.3) | 8 (14.8) | Strongly Disagree |
| 12 (22.2) | Disagree | ||
| 10 (18.5) | Neutral | ||
| 15 (27.8) | Agree | ||
| 9 (16.7) | Strongly Agree | ||
| If weight loss drugs were on formulary, I would prescribe them more frequently | 2.7 (1.0) | 7 (12.7) | Strongly Disagree |
| 18 (32.7) | Disagree | ||
| 16 (29.1) | Neutral | ||
| 14 (25.5) | Agree | ||
| 0 | Strongly Agree |
1 Scale of 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree