Barriers to weight loss among community health center patients: qualitative insights from primary care providers

BACKGROUND Community Health Centers (CHCs) are important settings for obesity prevention and control. However, few studies have explored the barriers that CHC clinicians perceive their patients face in maintaining a healthy weight. METHODS Semi-structured in-depth interviews were conducted with thirty physicians, physician assistants, and nurse practitioners recruited from four Community Health Centers (CHCs), located in a rural, southwestern region of the state of Georgia, US. Interviews were digitally recorded, transcribed verbatim, and thematically analyzed. RESULTS Clinicians perceived that their patients face numerous individual, interpersonal, and community-level barriers to weight loss. Perceived individual-level barriers included interrelated aspects of poverty and limited motivation to lose weight. Perceived interpersonal barriers included social and cultural norms, such as positive associations with larger body sizes, negative associations with smaller body sizes, lack of awareness of obesity as a problem, and beliefs regarding hereditary or generational body types. Perceived community-level barriers included limited healthy food options and aspects of the local food culture in the Southern US. CONCLUSIONS Clinicians perceived that their patients face barriers to weight loss at multiple levels of the social ecology, including individual, social, and environmental factors. Results may partly explain limited provision of weight counseling in CHCs and suggest opportunities for intervention.