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Table 1 Barriers associated with obesity management in the primary care setting

From: Provider views on childhood obesity management in primary care settings: a mixed methods analysis

Barriers Examples of comments
Provider-level/ Personal: Lack of knowledge and confidence, poor communication skills • “I feel nervous, like I’m in a very dangerous place, because I don’t want to mess anybody up and make it so they’re less happy. They’re already unhappy with themselves…”
• “I worry about using the words overweight and obese.”
• “So it stresses me out a little bit because some kid’s BMI may be over 85th percentile but they are an athlete or are otherwise healthy or the family is otherwise thin and they are going to grow out of it.”
• “It takes a few visits so that they trust you and…you are not judging them.”
• “The bigger problem with everything is actually knowing where – what to do for these folks.”
Practice-based/ systems level: Lack of time, poor training, lack of resources • “I would say there is a serious time management issue because there is a lot of material that we are supposed to be covering during the well-child check and although yes I know how to code for that extra visit at your well-child check, you don’t magically make time appear out of thin air… Getting the parents to buy in and getting the kid to buy in - that is an issue that takes time.”
• “We don’t want to go in and make it a big thing and make a 10 min visit into 30 min.”
• “So we need some more training… What works?... Do those scare tactics work? Has anyone studied it?”
• “I’ve had [motivational interviewing training] a little bit, but I’m not a professional in that respect, and I’d love to have someone who knows how to word it better than I do add it to our well-child visits.”
• “Even within [our] community there is a lot of confusion among the subspecialists as to who is dealing with what. What is the difference between [A] clinic and [B] clinic?”
Parent-level: Poor motivation, readiness, follow-up, and recognition of their child’s weight issues • “If they don’t think they’re overweight it’s really hard to get them to do stuff.”
• “I find it successful only if the patient has identified the problem and put it as their concern.”
• “If they are just a little bit obese, I will give them a 3 month period to diet and exercise, then come back and check everything… very rarely do they ever come back for that 3 month visit.”
• “I always tell them let’s come back… and they never come back.”
Environmental: Lack of access to services and lack of transportation • “Some of the problem I get is the access. If it’s like after school or… at night so the parents could go, but then the parents can’t go because they do not have day care you know, a babysitter for the other kids, or they have to work at night. They are doing the two job thing.”
• “Parents don’t like to travel, and they don’t have cars. Some people have to take the bus.”
• “If you bring it up for the parents they say, ‘It sounds great but I cannot drive there’.”