Women, Infants, and Children Providers' Perceptions of Managing Obesity in Pregnancy: A Qualitative Study

Obesity is exceedingly common among low-income pregnant mothers, a primary target population of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). While protocols at WIC address this nutritional problem, WIC nutritionists’ perceptions of the challenges of managing obesity in pregnancy are unknown. A qualitative study was conducted using data transcribed from audiotapes of focus groups among 27 Philadelphia WIC nutritionists to identify barriers and facilitators of counseling pregnant clients with obesity. Transcripts were coded for most common themes. Findings revealed 11 major themes clustered into three categories. The first category focused on barriers to counseling that WIC providers perceived were client driven. They perceived that mothers with obesity 1) were burdened by competing demands in their lives; 2) lacked interest in changing their nutrition behaviors; 3) misperceived their weight and healthfulness of diet; and 4) had difficulty prioritizing WIC input due to conflicting advice from others. The second category addressed barriers WIC providers perceived were WIC driven. They felt that 5) they were constrained by structural barriers at WIC; 6) counseling was protocol driven; and 7) they feared they would offend mothers. The last category described facilitators to creating more effective counseling sessions. Providers’ strategies were to 8) meet mothers where they are; 9) set small behavioral goals; 10) frame messages around baby’s development; and 11) build rapport early to establish trust. WIC nutritionists reported numerous barriers to counseling pregnant clients with obesity. Yet several potential solutions were uncovered, including: training WIC staff to use a patient-centered counseling approach; incorporating technology to overcome issues of time-management and follow-up; developing collaborations with family and other healthcare providers; and message framing around baby to help WIC clients adhere to nutrition goals.