The purpose of this study was to qualitatively and quantitatively evaluate the interactions between low-income, African American women who successfully lost weight and the healthcare system. This mixed methods study followed a positive deviance approach, identifying a population at high risk for obesity and then identifying positive deviants within this population. In this case, positive deviants were low-income, African American women who had been obese, and had successfully lost at least 10% of their weight and maintained this loss for at least six months. We collected data from electronic medical records (EMR) and participant surveys of both positive deviant cases, who had lost weight, and controls, who had not lost weight. To further evaluate these interactions, we conducted interviews with cases. We evaluated if physician documentation in the EMR of dietary counseling, a weight-related medical problem, or obesity were predictors of positive deviant group membership. We evaluated survey data to assess if participant report of physician counseling for weight loss, or a weight-related medical problem were predictors of positive deviant group membership. We found that physician documentation of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Documentation of obesity on the problem list was predictive of control group membership. Neither survey outcome was a significant predictor of positive deviant group membership. We identified four major themes from interviews with those who had lost weight: framing obesity in the context of other health problems provided motivation, having a full discussion around weight management was important, an ongoing conversation and relationship was helpful, and advice was helpful but only up to a point. In summary, physician counseling and having a weight related diagnosis were predictive of positive deviant group membership. Participants indicated a desire for more physician counseling and desired more specific guidance or referrals.
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Seaton Banerjee, MD, Elaine, "Low-Income African American Women's Perceptions of Primary Care Physician Weight Loss Counseling: A Positive Deviance Study" (2015). Master of Public Health Capstone Presentations. Presentation 164.