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Table 2 Key enablers and barriers for approaching the topic of nutrition

From: Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada - a qualitative study

Key enablers

Examples of quotes from primary care providers

Chronic disease diagnosis

“Sadly, when people have a chronic illness, it is much easier to talk about nutrition. I find the blood pressure helps, if there is an increase; I talk about weight, diet, and exercise.” CHC, NP – participant 20

Patients showing interest

“I would say a lot of times patients actually bring up the topic if I am talking to them about their cholesterol, they will ask what they can do that is not medication. If I am talking about diabetes or cholesterol, I let them know about the non-medical management, which is obviously the preferred route because there are no side effects as opposed to medications that have side effects.” CHC, FP– participant 17

Dietitian on site

“If somebody is coming in and they are here for a prescription renewal, it’s hard to focus time but because I do have the option to refer them to the dietitian, it’s a huge help.” NPLC, NP – participant 1

Out of normal range blood test markers

“If cholesterol is elevated, glucose is elevated, fatty liver based on lab results, regardless of the age of the person. If none of these issues are there, it is possible that I would not bring it up.” NPLC, FP – participant 9

Having access to handouts

“I like handouts because sometimes I know they are not necessarily listening and taking in the information as I am giving them. Let’s say their blood pressure is out of whack and they don’t want to come back to see the dietitian, I will print out the handout.” NPLC, NP – participant 1

Trusting relationship with the patient

“A trusting relationship between the health professional and the patient is number one.” CHC, NP – participant 19

The whole family has obesity

“When more than one family member has obesity, it is easier to bring up the topic of nutrition.” FHT, NP – participant 12

Key barriers

Examples of quotes from primary care providers

Lack of time

“Time consuming and we only have 15-min appointments so sometimes there is no time.” FHT, NP - participant 14

Patients not open to discussing it

“There are many clients who don’t want to hear about it. They’re unstably housed, they’re in abusive relationships, they have a lot of priorities and talking about nutrition and weight management is not among them.” CHC, NP – participant 18

Lack of rapport with the client

“Sometimes it’s the rapport. Some patients don’t care to interact.” NPLC, NP – participant 1

Competing demands

“They just have so many complex issues, mostly psychosocial issues that are predominant in their daily lives that nutrition is not something I can bring up.” CHC, NP – participant 19

Patient perceiving they already know what they need to change

“Some patients will say: yeah yeah, I’ve been told all this before, I know what to do, I just need to do it.” NPLC, NP – Participant 3

Low comfort level of provider to address nutrition

“Some providers may not be as comfortable because they think it is a sensitive topic but really if you just open a dialogue about it often times it will be OK to talk about it (nutrition).” NPLC, NP – Participant 2

Patients not understanding the implications of excess body weight

“I think that some patients may not understand some of the health consequences that could occur due to excess weight and unhealthy lifestyle behaviours” NPLC, NP – Participant 7