Communication StudyPhysician practice patterns of obesity diagnosis and weight-related counseling
Section snippets
Background
Clinical guidelines for obesity call for assessment (e.g., diagnosis) and management (e.g., dietary and exercise therapy) [1]. In addition, the U.S. Preventive Task Force recommends that clinicians screen all patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss [2]. Despite these guidelines, physician obesity care is sub-optimal and varies by patient characteristics [3], [4], [5], [6], [7], [8], [9], [10]. There is also evidence
Design
The study was a retrospective assessment of cross-sectional clinical encounter data from physician office visits.
Data
The data for this study was obtained from the 2005 National Ambulatory Medical Care Survey (NAMCS) – a national annual survey of patient visits reported by physicians [21]. Participating physicians were randomly selected from the master files of the American Medical Association and the American Osteopathic Association by geographical area and specialty. Only patient visits to the
Characteristics of the sample
Table 1 reports the characteristics of the study sample. Three-fourths of the study sample was White (75.3%), more than half were female (57.6%), two-thirds were age 45 and older (68.4%) and more than half had private insurance (57.0%). The majority of patients had a high or very high co-morbidity risk status (59.7%) and about half were class I obese (54.3%). About half of the patient visits were characterized as preventive or chronic (preventive, 14.8%; chronic 36.6%) and most patients had
Discussion
This paper examined whether obese patients receive an obesity diagnosis and weight-related counseling from their physician. Our secondary aim was to identify sociodemographic characteristics, physician characteristics, or characteristics of the clinical encounter associated with obesity diagnosis and weight-related counseling.
Our findings indicate that rates of obesity diagnosis and weight-related counseling were low in 2005, despite clinical guidelines suggesting that clinicians screen all
Conclusion
In summary, our findings suggest considerable missed opportunities in the diagnosis and management of adult obesity. Moreover, most obese patients with a higher underlying risk of excess weight (e.g., racial/ethnic minorities) do not have a higher likelihood of receiving obesity care after controlling for demographic characteristics, risk status, physician characteristics and characteristics of the clinical encounter.
Acknowledgements
Contributors: SNB and LAC conceived the study and developed the hypotheses. SNB analyzed the data. All authors contributed to the interpretation of study findings. SNB drafted the manuscript and all authors contributed to the final draft. SNB is the guarantor.
Competing interests: None declared.
Funding: This work was supported by two grants from the National Heart, Lung, and Blood Institute (1K01HL096409 and K24HL083113).
References (52)
- et al.
Diet and physical activity counseling during ambulatory care visits in the United States
Prevent Med
(2004) - et al.
Direct observation of physician counseling on dietary habits and exercise: patient, physician, and office correlates
Prevent Med
(2004) - et al.
Physician screening for multiple behavioral health risk factors
Am J Prevent Med
(2004) - et al.
Physician advice and support for physical activity: results from a national survey
Am J Prevent Med
(2001) - et al.
Obesity, weight loss, and physician's advice
Social Science Med
(2006) - et al.
Physician attitudes toward managing obesity: differences among six specialty groups
Prevent Med
(1997) - et al.
Diagnosis of obesity by primary care physicians and impact on obesity management
Mayo Clinic Proceed
(2007) - et al.
Physician evaluation of obesity in health surveys: “who are you calling fat?”
Social Sci Med
(2002) - et al.
Are physicians equipped to address the obesity epidemic? Knowledge and attitudes of internal medicine residents
Prevent Med
(2003) Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners
Prevent Med
(1995)
Family practice physicians’ beliefs, attitudes, and practices regarding obesity
Am J Prevent Med
Does physician weight affect perception of health advice?
Prevent Med
Dietary advice in clinical practice: the views of general practitioners in Europe
Am J Clin Nutr
Personal and professional nutrition-related practices of US female physicians
Am J Clin Nutr
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report, National Institutes of Health
Obes Res
Screening for obesity in adults: recommendations and rationale
Ann Intern Med
Are health care professionals advising obese patients to lose weight?
J Am Med Assoc
Trends in professional advice to lose weight among obese adults, 1994 to 2000
J Gen Intern Med
Underdiagnosis of obesity in adults in US outpatient settings
Archiv Intern Med
Who reports receiving advice to lose weight? Results from a multistate survey
Archiv Intern Med
National patterns of physician activities related to obesity management
Archiv Fam Med
The relationship between patient income and physician discussion of health risk behaviors
J Am Med Assoc
Patient perceptions and weight loss of obese adults
J Fam Pract
Physician advice about being overweight: association with self-reported weight loss, dietary, and physical activity behaviors of US adolescents in the National Health and Nutrition Examination Survey, 1999–2002
Pediatrics
Physicians’ weight loss counseling in two public hospital primary care clinics
Acad Med
How does physician advice influence patient behavior? Evidence for a priming effect
Archiv Fam Med
Cited by (132)
Striving for health equity: Stigmatizing language in inpatient pharmacy notes – A pilot study
2024, Research in Social and Administrative PharmacyEvaluation of weight loss counsel for Osteoarthritis patients: A cross-sectional analysis of NHANES 2011–2018
2024, Osteoarthritis and CartilageRole of Commercial Weight-Loss Programs in Medical Management of Obesity
2020, Endocrinology and Metabolism Clinics of North AmericaIncorporating Lifestyle Medicine Into Primary Care Practice: Perceptions and Practices of Family Physicians
2023, American Journal of Lifestyle Medicine