Perceived Barriers to Weight Management in Primary Care—Perspectives of Patients and Providers

BACKGROUND: Despite the consequences of overweight and obesity, effective weight management is not occurring in primary care. OBJECTIVE: To identify beliefs about obesity that act as barriers to weight management in primary care by surveying both patients and providers and comparing their responses. DESIGN: Anonymous, cross-sectional, self-administered survey of patients and providers of a Veteran’s Administration Primary Care Clinic, distributed at the clinic site. SUBJECTS: Forty-eight Internal Medicine providers and 488 patients. MEASUREMENTS: Beliefs, attitudes, and experiences with weight management as well as demographic characteristics were collected through a questionnaire. RESULTS: Providers and patients differed significantly on many beliefs about weight. Providers were more likely than patients to perceive that patients lack self-control to stay on a diet and that fattening food in society and lack of time for exercise were prime factors in weight gain. They also expressed more interest in helping patients with weight management than patients desiring this. Patients were more likely to state that weight problems should be managed on one’s own, talking to a provider is not helpful, providers blame them for their weight problem, and that appointments contain sufficient time for weight discussion. CONCLUSION: Providers and patients emphasize different barriers to weight management. Providers need to be aware of the beliefs that their patients hold to improve weight management discussions and interventions in primary care

Prepregnancy body mass index and dietary intake in the first trimester of pregnancy

Objectives: Adequate maternal nutrition is of paramount importance in pregnancy, particularly in the first trimester when fetal development is crucial. It has been reported that heavier women are most likely to fear weight gain associated with pregnancy. Few studies have, however, investigated associations between prepregnancy body mass index (BMI) and nutrient intakes in the first trimester of gestation using detailed, prospective methodologies. The aim of this study was to investigate possible associations between prepregnancy BMI and nutrient intakes in the first trimester of gestation. Design: Seventy-two Caucasian, primiparous nonsmokers of mean age 33.1 years (SD 4.6) were recruited from three London teaching hospitals and they completed a background information questionnaire and a 4- to 7-day weighed inventory food diary during the first trimester of pregnancy. Prepregnancy anthropometric data were extracted from General Practitioner records. Results: Prepregnancy BMI was inversely associated with dietary energy (P = 0.04), Southgate and Englyst fibre (P < 0.01), and iron and folate (P < 0.01). After excluding under-reporters [individual energy intake:basal metabolic rate (estimated) ratio < 1.2], prepregnancy BMI was inversely associated with folate intake (P =0.04). Dietary intakes of Englyst fibre (P = 0.03) were statistically significantly lower than average dietary recommendations in this group. Conclusions: This study identified that women with a high prepregnancy BMI are more likely to under-report nutrient intakes. The finding that folate intake was significantly lower in heavier women accurately reporting dietary intake is of particular concern

Depression, nutritional risk and eating behaviour in older caregivers

Objective This study investigated the relationship between depression, nutritional risk and dietary intake in a population of older caregivers. Design Mailed questionnaire with sub group participating in a home-based interview.Participants and setting Seventy-six community dwelling caregivers aged 50 y or over from Victoria, Australia.Measurements Questionnaires provided information on weight, height, hours of care, depressive symptoms, nutritional risk and appetite. The home-based interview assessed dietary intake and shopping, cooking and meal consumption habits. Results The sample had a mean&plusmn;SD age of 70.3&plusmn;12.8 y, BMI of 27.2&plusmn;4.8 kg/m2 and the time spent caring was 101.8&plusmn;68.1 h/wk. Overall, 32% of caregivers had depressive symptoms, 21% were at risk of malnutrition and 21% reported their appetite was fair/bad/very bad. Caregivers with depressive symptoms (32%) compared to those with no depressive symptoms (53%) had a poorer appetite (p&lt;0.05). Of the 20 caregivers who participated in the home interview, 25% reported they ate their meals alone. Conclusion A significant proportion of community dwelling older caregivers had depressive symptoms, were at risk of malnutrition and had poor appetites, although the majority were overweight or obese.<br /