Abstract
Objective
To examine interest, resources, and preferences for weight loss programs among primary care patients with obesity.
Methods
Primary care patients having a BMI ≥30kg/m2 were recruited in the summer and fall of 2018. Eligible patients were invited to complete an anonymous survey assessing sociodemographic factors, interest in weight loss, resources, and preferences for weight loss programs. Descriptive statistics were used for analysis.
Results
A total of 77 patients completed the anonymous survey. Nearly 90% of patients were interested in participating in a weight loss program and reported having a smartphone. Approximately 80% had high-speed internet and a device with videoconferencing capabilities, whereas only 40% had a tablet or laptop computer. On average, patients preferred weight loss programs delivered in-person and led by a nutritionist or personal trainer. Patients’ top three preferences for weight loss content included goal setting, staying motivated, and finding ways to be more active.
Conclusions
Although primary care patients with obesity were interested in weight loss programs, availability of resources and preferred program characteristics varied.
Practice Implications
This study provides insight on patient interest, resources, and preferences for weight loss programs that may help guide the development of future programs.
Keywords: Patient preferences, weight loss programs, primary care, obesity
1. Introduction
Obesity is a global concern [1] that is associated with adverse health outcomes including type II diabetes, hypertension, most cancers, cardiovascular diseases, asthma, back pain, and osteoarthritis [2]. Intensive, multicomponent behavioral weight loss interventions are recommended for managing adult obesity but can be impractical to implement in primary care settings [3]. Brief clinic-based weight loss interventions delivered by physicians, nurse practitioners, and registered dieticians have been effective in decreasing body weight [4], and interventions facilitated by lifestyle coaches without extensive behavioral change experience have also been effective [5–7]. An important factor associated with weight loss outcomes is program attendance, with those attending fewer sessions experiencing less weight loss [6, 7]. As an alternative to face-to-face weight loss programs, researchers have tested remote treatment modalities including the telephone, Internet, and email with favorable body weight changes reported [8–10]. However, certain patient populations, such as those who are socioeconomically disadvantaged, may lack necessary resources to participate in technology-based weight loss programs [11].
While weight loss programs can be effective in facilitating weight loss, only about 10% of adults with obesity report using formal programs [12], program adherence is suboptimal [13], and attrition is often high [14]. Tailoring programs to participants’ needs and preferences may be an important strategy for improving program initiation and engagement [15–17]. Evidence also suggests that having a program leader and participating with others influences perceptions of intervention effectiveness and the decision to participate [17]. To inform future program development, we explored patient preferences and resources for weight loss programs among a sample of primary care patients with obesity.
2. Methods
This cross-sectional, survey-based study was conducted at a primary care clinic in the Southeast US. Patients were eligible if they had obesity (body mass index [BMI] ≥30kg/m2) and could read and understand English. The brief survey assessed sociodemographic characteristics, weight loss programs interest, weight loss attempts, height, weight, resource availability, and weight loss program preferences (Appendix A). The survey was modeled after surveys assessing weight loss preferences among patients undergoing knee arthroplasty [18] and willingness to participate in weight loss programs among patients in the Northwest [19]. Patients were asked to rank order 9 different weight loss program modalities from 1–9 with 1 being the most preferred modality and 9 being the least preferred modality. Similarly, patients were asked to rank order 7 different weight loss program leaders from 1–7. For these questions, a lower average ranking indicates a stronger preference for a weight loss modality and program leader. Self-reported height and weight were used to calculate BMI.
This study received an exemption from human research subject regulations (Pro00079217) by the University of South Carolina Office of Research Compliance. Participants were recruited using flyers placed throughout the clinic and clinician referral. Surveys were completed during clinic visits and secured in a locked collection box. Descriptive statistics were used for data analysis using SPSS version 25.
3. Results
3.1. Sample Characteristics
A total of 77 patients completed the survey. The sample was predominantly female with an average age of 46 years and an average BMI of 42kg/m2 (Table 1). Approximately three-fourths of participants had some level of college education, two-thirds were Black or African America, and one-fifth were White/Caucasian. Approximately 90% of participants expressed interest in participating in a weight loss program.
Table 1.
Characteristics of the Sample (n = 77)
| Characteristic |
Mean ± SD or n (%) |
|---|---|
| Gender | |
| Female | 72 (94) |
| Male | 5 (6) |
| Race | |
| African American | 51 (67) |
| Caucasian | 17(22) |
| Multiracial | 5 (7) |
| Other | 3 (4) |
| Age (years) | 46 ± 13 |
| Education | |
| Less than high school | 7 (9) |
| High school/GED | 12 (16) |
| Some college | 25 (33) |
| Trade school | 1 (1) |
| Associate degree | 1 (1) |
| Bachelor’s degree | 15 (20) |
| Master’s degree | 12 (16) |
| Doctoral degree | 3 (4) |
| Marital status | |
| Single | 32 (42) |
| Married | 18 23) |
| Divorced | 16 (21) |
| Separated | 7 (9) |
| Widowed | 3 (4) |
| Cohabitating | 1 (1) |
| Body mass index (kg/m2) | 42 ± 11 |
| Interested in Weight Loss Program | |
| Yes | 69 (95) |
| No | 4(5) |
Notes: Missing data or implausible values for age (n = 3), education (n = 1), body mass index (n = 12), and interest in weight loss program (n = 4)
3.2. Weight Loss Program Resources
Nearly 90% of the sample reported having a smartphone, and approximately 80% reported high-speed internet access and a device with videoconferencing capabilities (Table 2). Roughly 40% reported having a tablet or laptop computer, and only 14% reported having a desktop computer.
Table 2.
Patient Resources for Participating in Weight Loss Programs (n = 77)
| Resources |
N (%) Responding “Yes” |
|---|---|
| Internet | 64 (83) |
| High-speed internet | 59 (77) |
| Videoconferencing-capable device | 62 (81) |
| Smartphone | 68 (88) |
| Tablet | 30 (39) |
| Laptop computer | 33 (43) |
| Desktop computer | 11(14) |
3.3. Preferences for Weight Loss Program Modality
There were 36 surveys with usable data for the question regarding preferences for weight loss modalities. Participants generally preferred face-to-face, in-person individual and face-to-face, in-person group modalities with average rankings of 2.7 and 3.9, respectively (Table 3). Approximately 70% and 50% of participants listed a face-to-face, in-person individual modality or a face-to-face, in person group modality as their 1st or 2nd preferred choice, respectively. Although a face-to-face, in-person group modality was the second most preferred weight loss program modality based on average ranking, 14% listed this as their least preferred modality. On average, the least preferred modality was a phone-based group program with an average ranking of 6.1. Average rankings for other delivery methods ranged from 5.1 to 5.7.
Table 3.
Preferences for Weight Loss Program Modality (n = 36)
| Modality | N (%) 1st Choice | N (%) 2nd Choice | N (%) Last Choice | Average Ranking |
|---|---|---|---|---|
| Face-to-face, in-person individual | 14 (39) | 10 (28) | 0 (0) | 2.7 |
| Face-to-face, in-person group | 12 (33) | 6 (17) | 5 (14) | 3.9 |
| Internet-based | 3 (8) | 5 (14) | 2 (6) | 5.1 |
| Face-to-face, video individual | 1 (3) | 6 (17) | 7 (19) | 5.1 |
| Phone individual | 0 (0) | 2 (6) | 2 (6) | 5.2 |
| Self-paced DVD | 3 (8) | 2 (6) | 7 (19) | 5.6 |
| Text-messaging based | 1 (3) | 3 (8) | 6 (17) | 5.6 |
| Face-to-face video group | 2 (6) | 2 (6) | 3 (8) | 5.7 |
| Phone group | 0 (0) | 0 (0) | 4 (11) | 6.1 |
Note: Participants were asked to rank order weight loss program modalities from 1–9 with 1 being the most preferred modality and 9 being the least preferred modality. A lower average ranking indicates a stronger preference for a weight loss program modality.
3.4. Preferences for Weight Loss Program Leader
There were 43 surveys with usable data for the question regarding preferences for weight loss program leaders. On average, patients preferred a nutritionist and personal trainer for leading a weight loss program, with average rankings of 2.6 and 3.2, respectively (Table 4). Approximately 50% of participants preferred a nutritionist as their 1st or 2nd choice, and no participant listed a nutritionist as their last choice. Comparatively, 44% preferred a personal trainer as their 1st or 2nd choice, and 7% listed a personal trainer as their last choice. On average, the least preferred leader for a weight loss program was a registered nurse with an average ranking of 5.0. Average rankings for other program leaders ranged from 3.6 to 4.8.
Table 4.
Preferences for Weight Loss Program Leader (n = 43)
| Person | N (%) 1st Choice | N (%) 2nd Choice | N (%) last Choice | Average ranking |
|---|---|---|---|---|
| Nutritionist | 9 (21) | 13 (30) | 0 (0) | 2.6 |
| Personal Trainer | 15 (35) | 4 (9) | 3 (7) | 3.2 |
| Nurse Practitioner | 8 (19) | 7 (16) | 4 (9) | 3.6 |
| Successful Peer | 7 (16) | 6 (14) | 9 (21) | 4.1 |
| Physician | 3 (7) | 7 (16) | 9 (21) | 4.7 |
| Health Psychologist | 1 (2) | 5 (12) | 10 (23) | 4.8 |
| Registered Nurse | 0 (0) | 1 (2) | 8 (19) | 5.0 |
Note: Participants were asked to rank order weight loss program leaders from 1–7 with 1 being the most preferred leader and 7 being the least preferred leader. A lower average ranking indicates a stronger preference for a weight loss program leader.
3.5. Preferences for Weight Loss Program Content
There were 74 surveys with usable responses for preferences for weight loss program content. Goal setting, staying motivated, and ways to be more physically active were selected as being of most interest with 84%, 76%, and 73% of participants selecting these content areas, respectively (Table 5). Roughly two-thirds of participants were interested in eating less fat and calories and with getting back on track. Stress management and eating away from home were of interest to approximately 60% of participants, whereas food labels was of least interest with about 50% selecting this content area.
Table 5.
Preferences for Weight Loss Program Content (n = 74)
| Content Area |
N (%) |
|---|---|
| Goal setting | 62 (84) |
| Staying motivated | 56 (76) |
| Ways to be more active | 54 (73) |
| Eating less fat and calories | 50 (68) |
| Getting back on track | 50 (68) |
| Stress management | 47 (64) |
| Eating away from home | 46 (62) |
| Food labels | 39 (53) |
4. Discussion and Conclusion
4.1. Discussion
This study provides insight about the interest, resources, and preferences for weight loss programs among primary care patients with obesity. Approximately 90% of patients expressed interest in participating in a weight loss program, and a nutritionist was the preferred program leader. This finding is consistent with research in which 86% of adults with obesity indicated a desire to lose weight with 64% wanting a dietitian referral [20]. In another study of more than 1400 primary care patients in the Northwest US, 63% indicated a willingness to participate in a comprehensive weight loss program [19]. Our findings suggest that patients with obesity are interested in losing weight and are willing to participate in programs led by people other than a primary care provider. Such evidence is important given that primary care providers spend just over 4 minutes per visit counseling patients about exercise and nutrition [21] and that only 8% of providers’ time in primary care visits is attributed to overweight and obesity [22].
The preference for face-to-face weight loss programs observed in the current study differs from previous research in which older patients scheduled for or having undergone knee arthroplasty tended to prefer a telephone-based program rather than a face-to-face program [18]. In another study involving clinician referral to community weight loss resources, participants’ preference for weight loss counseling was through Weight Watchers, followed by usual care, telephone-based counseling, and electronic counseling [23]. Proportionately more females and younger participants chose the group-based Weight Watchers program, which was selected by those who valued its support as compared to those who chose telephone counseling due to convenience. Different patient preferences for program modalities may therefore be influenced by factors such as mobility and travel limitations, time constraints, social support needs, and level of motivation. Lack of motivation may have been a substantial issue among participants in the current study given that staying motivated was one of the top choices for weight loss program content.
Several limitations to this study should be noted. Invalid responses were provided for some survey questions, and several questions and response options were left blank. These data were excluded from analysis. The questions about rank ordering preferences were particularly prone to response error. For example, when asked to rank order preferences for weight loss program modality, some participants appeared to individually rank each modality (e.g., both an internet-based program and text-messaging program ranked as a 5). Approximately 16% of participants appeared to rank each individual modality on a scale from 1–10. Data were not collected on patients who declined to complete the survey. Consequently, findings may reflect the interest, resources, and preferences among patients interested in losing weight. Finally, our findings may not be generalizable to men given that more than 90% of participants were female.
4.2. Conclusions
Comprehensive, multicomponent behavioral interventions are recommended to address obesity. Our findings suggest that primary care patients with obesity are interested in weight loss programs but have different resources and preferences for program characteristics.
4.3. Practice Implications
Findings from this study may help guide the development of future weight loss programs that are tailored to patient resources and preferences. Tailoring weight loss programs to patient resources and preferences may have important implications related to treatment initiation and engagement.
Supplementary Material
Highlights.
Tailoring weight loss programs to patient preferences may influence adherence.
Only 40% of patients had a laptop computer or tablet, but 90% had a smartphone.
Patients had a stronger preference for in-person weight loss programs.
Nutritionists and personal trainers were the most preferred program leaders.
Study findings may help inform future weight loss programs.
Acknowledgments
Funding
This study was funded by a grant from the University of South Carolina College of Nursing Office of Research. Dr. Demetrius Abshire was supported (in part) by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number K23MD013899. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Footnotes
Declaration of Competing Interest
The authors declare no conflicts of interest.
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