Implementation of weight-inclusive care in primary care: a mixed-methods pilot study of a brief, behavior-focused provider training

Abstract

Introduction Weight stigma remains prevalent in health care, adversely impacting patient outcomes and perpetuating health disparities. Weight-inclusive care (WIC) aims to improve health independent of weight through personalized and sustainable changes to health promoting behaviors and reduced weight stigma, yet little research has examined how to support its implementation in primary care. Methods This convergent parallel design mixed methods study piloted a brief pragmatic intervention to facilitate adoption of WIC at a federally qualified health center, evaluating feasibility, acceptability, and preliminary implementation outcomes focused on adoption of WIC clinical behaviors rather than attitude change. 10 providers participated in the training, with four completing follow-up interviews. Participants completed online surveys at baseline (n = 9) and two-week follow up (n = 10) assessing acceptability, attitudes, and self-reported clinical behaviors. Quantitative data were analyzed using Wilcoxon matched-pairs signed-rank tests, thematic analysis was used to analyze interview transcripts for further insight into the implementation of practice changes. Results Although changes in self-reported attitudes and clinical behaviors were not statistically significant, providers reported making modifications to the physical environment and clinic workflows in qualitative interviews, including changes that affected weighing procedures, documentation, communication strategies, and improved accessibility of appropriately sized equipment. Interviews further identified organizational and structural barriers to implementation and revealed a recurring disconnect between WIC knowledge and application. Discussion Findings suggest adoption of WIC involves more than acquiring new knowledge and may require fundamental changes to clinical reasoning, organizational support, and healthcare infrastructure. Behavior-focused implementation strategies may facilitate early adoption of WIC and represent a promising alternative to traditional attitude-focused interventions. Organizational support and accountability mechanisms are likely needed to effectively support this paradigm shift. Larger studies with validated behavioral measures and longer follow-up are needed to evaluate sustained implementation and patient outcomes.