The Joys and Challenges of Delivering Obesity Care: a Qualitative Study of US Primary Care Practices

Abstract

BACKGROUND: Obesity is of epidemic proportion in the USA but most people with obesity do not receive treatment. OBJECTIVE: To explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. The study's focus was on examining the use of the Medicare payment code for intensive behavioral therapy for obesity (IBT), but other obesity management services and payment mechanisms were also studied. DESIGN/PARTICIPANTS: We conducted 85 interviews of clinicians (physician, advanced practice clinicians, registered dietitian, or other) practicing in primary care practices. Interviews gathered information about treatment approach to obesity, barriers, and facilitators to providing obesity care including the handling of billing and reimbursement (especially use of the IBT code), personal beliefs about the appropriateness of primary care providing weight loss services, and recommendations for improving weight management in primary care practice. The analysis was conducted using a grounded theory hermeneutic editing approach and the constant comparative method. KEY RESULTS: Seventy-five interviews were included in this analysis. We identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile. CONCLUSIONS: Treating obesity in primary care settings poses several challenges but can also be very satisfying and rewarding. To improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.

Primary care provider uptake of intensive behavioral therapy for obesity in Medicare patients, 2013–2019

“…This relationship between the patient composition and provider IBT-uptake was consistent with the need for obesity management in patients with high lipids. These patterns were consistent with practicelevel characteristics associated with IBT uptake (e.g., larger practices are more likely to use IBT) [18], geographic distribution of the Medicare population with obesity (e.g., prevalence of beneficiaries with obesity is highest in the South) [19], and the complexity of obesity management (e.g., some PCPs such as nurse practitioners need more formal training for treating obesity) [20].…”

A Survey of Primary Care Practices on Their Use of the Intensive Behavioral Therapy for Obese Medicare Patients

“…A companion paper details the reasons why practices do not use IBT through key informant interviews. 19…”

An Assessment of Weight Loss Management in Health System Primary Care Practices

“…[7][8][9][10] Although clinicians note the high importance of treating patients' obesity as a standard of care, 11 barriers include insufficient clinician training/familiarity with obesity treatment; challenges with access for/prioritization of obesity treatment; lack of workable structures, workflows, and resources; and low/no reimbursement for direct provision of obesity care without other comorbidities. [12][13][14][15] Patients also face many barriers including stigma, lack of motivation, ability to successfully lose weight, and cost and lack of access to services. [16][17][18][19] However, recent research reveals that practices can, in fact, deliver obesity care if the barriers are identified and addressed.…”

“…[16][17][18][19] However, recent research reveals that practices can, in fact, deliver obesity care if the barriers are identified and addressed. 12,20 With structures and supports in place, patients are achieving weight loss outcomes that have potential to slow the public health trends toward increasing obesity and the resulting comorbid conditions. [21][22][23][24][25][26] Understanding more about what motivates primary care practice members toward providing obesity care and what steps could be taken to overcome perceived barriers is needed.…”