Table 3.

Barriers to Weight Gain Counseling Among Prenatal Care Providers

Category	Theme	Representative quote	Potential intervention or future research
Knowledge	Lack of formal training (especially OB/GYNs) a	“I wish we had better education … in medical school. I don't feel like I'm very prepared to give great nutrition counseling.” (OB/GYN)	Continuing medical education (CME); use of technology (e.g., computer or web-based counseling tools)
Attitudes	Uncertainty, doubt about counseling effectiveness	“It's not something they have that much control over, is what I really believe, so … I don't want them to be more anxious.” (OB/GYN)	Research on effectiveness of interventions to optimize gestational weight gain; encouraging goal setting with follow-up so providers can observe results
	Sensitivity of topic	“And having weight issues my whole life … I'm really aware … about being respectful of patients and not shaming them around weight gain.” (NP)	Counseling strategies that are sensitive yet still address nutrition and weight gain; research to study patient attitudes toward weight gain counseling and culturally competent methods for providing education and counseling
Behaviors	Reactive approach; lack of baseline assessment	“If I identify someone who's gaining … too much weight … I usually ask them to do a 24-hour diet recall and try to do some really targeted counseling.”(CNM)	Development of a brief, focused assessment tool; emphasis on anticipatory guidance and education on weight management throughout pregnancy
	Use personal experiences in counseling	“Being overweight myself is a great icebreaker for women who are struggling with it. …  I can relate my own struggles to it.” (CNM)	Research to study patient response to provider personal stories

^a OB/GYNs, obstetrician/gynecologists; CNMs, certified nurse midwives; NPs, nurse practitioners.