Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary care: a qualitative study

Abstract

Background: Over 1 million Canadians have class II or III obesity; however, access to weight-loss interventions for these patients remains limited. The purpose of our study was to identify the barriers to accessing medical and surgical weight-loss interventions from the perspectives of 3 groups: family physicians, patients who were referred for weight-loss intervention and patients who were not referred for weight-loss intervention.Methods: Between November 2017 and May 2018, we conducted a qualitative exploratory research study using focus groups with family physicians and interviews with patients with class II or III obesity from 1 region in southern Ontario. We conducted a thematic analysis to identify emergent themes and used the barriers to change theory to classify the similarities and differences between the perspectives of family physicians, referred patients and nonreferred patients in first-and second-order barriers.Results: Seventeen family physicians participated in 7 focus groups (1-4 participants/group), and we interviewed 8 referred patients and 7 nonreferred patients. We identified lack of resource supports, logistics and lack of knowledge about weight-loss interventions as first-order barriers to change, and lack of knowledge about root causes of obesity, lack of patient readiness for change and family physicians' perceptions about surgical weight loss as second-order barriers to change. Family physicians and patients had similar perceptions regarding lack of resource supports in the community, logistical issues, family physicians' lack of knowledge regarding weight-loss interventions, patients' lack of motivation and family physicians' perceptions of bariatric surgery as being high risk. They differed regarding the root cause of obesity, with family physicians attributing obesity to multiple extrinsic and intrinsic causes, whereas patients believed obesity was largely due to intrinsic causes alone.Interpretation: It is important to address first-and second-order barriers to accessing weight-loss interventions through continuing professional development activities for family physicians to help ensure effective and timely treatment for patients with class II or III obesity and related comorbidities. AbstractResearch OPEN CMAJ OPEN, 7(4) E739Affiliations:

Survey of perceptions and educational needs of primary care providers regarding management of patients with class II and III obesity in Ontario, Canada

“…These findings are in agreement with a 2014 Ontario survey [ 25 ], which reported that over 70% of physicians have referred no more than 5% of their patients with class II/III obesity for BS. Plausible explanations for the low referral rate include lack of knowledge by PCPs about risks and benefits of contemporary BS, and the role that BS can play in helping patients with obesity improve their quality of life [ 26 ].…”

“…In our study, more than one third of all PCPs were hesitant to refer patients for BS due to concerns about complications and risks associated with surgery, and medical complications after surgery. In a recent qualitative study of PCPs in Southeastern Ontario, we identified that most PCPs viewed BS as high-risk, with significant short- and long-term post-operative complications [ 26 ]. PCPs also viewed BS as a last resort after unsuccessful attempts at all other weight loss interventions [ 26 ].…”

“…In a recent qualitative study of PCPs in Southeastern Ontario, we identified that most PCPs viewed BS as high-risk, with significant short- and long-term post-operative complications [ 26 ]. PCPs also viewed BS as a last resort after unsuccessful attempts at all other weight loss interventions [ 26 ]. Other studies have highlighted similar concerns of PCPs about associated risks of BS [ 27 – 30 ].…”

Survey of Perceptions and Educational Needs of Primary Care Providers Regarding Management of Patients with Class II and III Obesity in Ontario, Canada

“…These ndings are in agreement with a 2014 Ontario survey [27], which reported that over 70% of physicians have referred no more than 5% of their patients with class II/III obesity for BS. Plausible explanations for the low referral rate include lack of knowledge by PCPs about risks and bene ts of contemporary BS, and the role that BS can play in helping patients with obesity improve their quality of life [28].…”

“…In our study, more than one third of all PCPs were hesitant to refer patients for BS due to concerns about complications and risks associated with surgery, and medical complications after surgery. In a recent qualitative study of PCPs in Southeastern Ontario, we identi ed that most PCPs viewed BS as high-risk, with signi cant short-and long-term post-operative complications [28]. PCPs also viewed BS as a last resort after unsuccessful attempts at all other weight loss interventions [28].…”