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

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.