Communication Study
Physician practice patterns of obesity diagnosis and weight-related counseling

https://doi.org/10.1016/j.pec.2010.02.018Get rights and content

Abstract

Methods

We analyzed cross-sectional clinical encounter data. Obese adults were obtained from the 2005 National Ambulatory Medical Care Survey (N = 2458).

Results

A third of obese adults received an obesity diagnosis (28.9%) and approximately a fifth received counseling for weight reduction (17.6%), diet (25.2%), or exercise (20.5%). Women (OR = 1.54; 95% CI: 1.14, 2.09), young adults ages 18–29 (OR = 2.61; 95% CI: 1.37, 4.97), and severely/morbidly obese individuals (class II: OR 2.08; 95% CI: 1.53, 2.83; class III: OR 4.36; 95% CI: 3.09, 6.16) were significantly more likely to receive an obesity diagnosis. One of the biggest predictors of weight-related counseling was an obesity diagnosis (weight reduction: OR = 5.72; 95% CI: 4.01, 8.17; diet: OR = 2.89; 95% CI: 2.05, 4.06; exercise: OR = 2.54; 95% CI: 1.67, 3.85). Other predictors of weight-related counseling included seeing a cardiologist/other internal medicine specialist, a preventive visit, or spending more time with the doctor (p < 0.05).

Conclusions

Most obese patients do not receive an obesity diagnosis or weight-related counseling.

Practice implications

Preventive visits may provide a key opportunity for obese patients to receive weight-related counseling from their physician.

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).

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