Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight

Abstract

Purpose:

Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight and their primary care physicians (PCPs).

Design:

Mixed methods, positive deviance study.

Setting:

Urban university-based family medicine practice.

Participants:

The positive deviance group comprised low-income, African American women who were obese, lost 10% body weight, and maintained this loss for 6 months.

Measures:

The PCP- and patient-reported weight-related variables collected through the electronic medical record (EMR), surveys, and interviews.

Analysis:

Logistic regression of quantitative variables. Qualitative analysis using modified grounded theory.

Results:

The EMR documentation by PCPs of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Qualitative analyses of interviews revealed 5 major themes: framing obesity in the context of other health problems provided motivation; having a full discussion around weight management was important; an ongoing relationship with the physician was valuable; celebrating small successes was beneficial; and advice was helpful but self-motivation was necessary.

Conclusion:

The PCP counseling may be an important factor in promoting weight loss in low-income, African American women. Patients may benefit from their PCPs drawing connections between obesity and weight-related medical conditions and enhancing intrinsic motivation for weight loss.