Table 2:

Selected quotes for theme 1: first-order barriers to change

SubthemeRepresentative quote
Resource supportsThe clinics that I am involved with, they are pretty well equipped, to be honest. … All the ones that I have worked in have specific weight-loss programs. At [location], it is “healthy weight, healthy you.” In [alternative location] family health team, it is the metabolic change program. So, the programs are available, and I feel we are well supported in that way. (family physician 10)
We don’t have anyone to turn to or to direct people to. Some people come in and are quite motivated. They want to meet with the dietitian, and they know that their friend who is a patient at a [family health] team has met with a dietitian at their family doctor’s office. So why can’t that happen [for them]? It is unfair, mostly for the patient. (family physician 2)
Plus she sent me to the … nutritional program at the hospital. … Each level that I wanted to take or each different … platform that they were supposed to deliver that I wanted … they said “Oh, right now we’re not doing that one.” (nonreferred patient 6)
I was doing exercise at the pool. … My wife and I were going for about 5 or 6 years and we were doing aquafit. But the town closed the pool. And when that happened, that exacerbated my weight issues and my blood pressure issues. (referred patient 2)
LogisticsI find the other barrier is lack of time. If I could sit with them [patients] and do a motivational speech to them every week, I bet you I could help them stay on plan. But I just don’t have that kind of time, and I don’t have someone in my office who does. … And certainly, the cost … liraglutide is horribly expensive. So, you have to be well [off] to afford it. (family physician 5)
I only have so much time, and then she [family physician] is off to the next appointment. I don’t think the time necessary is afforded for the patient. I feel like I am in, I talk about whatever is bothering me, “Here is a prescription to take care of it” and off to the next patient. (referred patient 6)
The doctor’s not available. The clinic’s not open. They work limited hours, and if you want an appointment you have to wait an inordinately long time to get one. (nonreferred patient 1)
I have so few people who will go to a private dietitian because of the cost. (family physician 1)
I went to Herbal Magic and that was expensive. I did lose my weight, but I couldn’t afford to keep that up. (referred patient 3)
Even just basic things like transport to the bariatric program, for instance, is very costly, especially if you are morbidly obese because you require more expensive patient transfer than just taking the access bus, for instance. (family physician 4)
Consultation with specialists — is there a specialist around? I would be happy to refer. I don’t know any. (family physician 13)
Lack of knowledgeI wish they [family physicians] were more knowledgeable on different options. They are, like, “Oh, you have weight issues, then go see a dietitian.” “Oh, you still have weight issues, then exercise.” I could literally search that on Google. There is no in-depth. … That is why I say I think doctors should be educated on that enough to sit down with the person and give [him or her] that information instead of saving it for when you get into the program. (referred patient 4)
She [family physician] didn’t really know about the bariatric clinic. So basically I kind of told her and then she looked into it. .… So, I mean, she did do the research after she found out about it. (nonreferred patient 4)
But managing [patients] afterwards? It is, like, “You have an issue? Go to your surgeon.” … All these wonderful vitamins that they are on, and they get blood work done every month. And there is this dumping syndrome and postsurgical hyporeactive glycemia. And I am, like, “I don’t know what is going on.” … When you’re looking at a population that is marginalized financially, marginalized from an educational perspective … you’re dealing with a knowledge deficit. (family physician 11)
I am thinking, too, for myself. Physicians are expected to be a motivator. … How am I going to talk about the weight or the diabetes? I have never had any training to be able to put myself in that person’s shoes and understand stuff. (family physician 8)
I suppose that if [patients] were morbidly obese, I might bring up surgery at some point, although I find that a very sensitive topic. People feel like they’re a lost cause. (family physician 15)
With the bariatric surgery, the weight-loss surgery … maybe if the doctor could mention more about how it is done and if there will be any side effects, how long the recovery time will be, whether it’s months or years. It might be useful information. (nonreferred patient 07)
[I don’t know] the resources in the community. To be honest, other than knowing what is in my hospital, I don’t really know where to refer people. (family physician 10)
Some of them [patients] don’t acknowledge that their weight is a problem at all. And they’re quite comfortable with their weight being what it is and don’t see it as an issue, even though they may have comorbidities. (family physician 12)