Documentation and Management of Overweight and Obesity in Primary Care

Purpose: We examined overweight/obesity management in primary care in relation to body mass index (BMI), documentation of weight status, and comorbidities. Methods: This analysis of baseline data from the Cholesterol Education and Research Trial included 2330 overweight and obese adult primary care patients from southeastern New England. Data were obtained via a telephone interview and abstraction of patients’ medical records. BMI (kg/m2) was calculated from measured height and weight. Management of overweight/obesity included advice to lose weight, physical activity recommendations, dietary recommendations, and referral for nutrition counseling. Results: Documentation of weight status was more common with increasing BMI (13% of overweight patients, 39% of mildly obese patients, and 77% of moderately/severely obese patients). Documentation of overweight/obesity was associated with increased behavioral treatment; the biggest increase was seen for advice to lose weight (odds ratios were 7.2 for overweight patients, 3.3 for patients with mild obesity, and 4.0 for patients with moderate/severe obesity). Although weight-related comorbidities were associated with increased overweight/obesity management at all BMIs, the biggest increase in odds was for patients with moderate/severe obesity. Conclusions: Documentation of weight management was more common among patients with documented overweight/obesity and with weight-related comorbidities. These insights may help in designing new interventions in primary care settings for overweight and obese patients.

[1]  David Young,et al.  Research Paper: Patient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging , 2004, J. Am. Medical Informatics Assoc..

[2]  M. A. van 't Hof,et al.  Consumers' expectations about nutrition guidance: the importance of primary care physicians. , 1997, The American journal of clinical nutrition.

[3]  Elyse R Park,et al.  Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers. , 2005, Journal of general internal medicine.

[4]  Steven H. Woolf,et al.  A Practice-Sponsored Web Site to Help Patients Pursue Healthy Behaviors: An ACORN Study , 2006, The Annals of Family Medicine.

[5]  M. A. van 't Hof,et al.  Nutrition guidance by primary-care physicians: perceived barriers and low involvement. , 1995, European journal of clinical nutrition.

[6]  D. Schoenfeld,et al.  National patterns of physician activities related to obesity management. , 2000, Archives of family medicine.

[7]  A. Berg.  Screening for obesity in adults: recommendations and rationale. , 2004, The American journal of nursing.

[8]  K. Grumbach,et al.  Group medical visits for low-income women with chronic disease: a feasibility study. , 2004, Journal of women's health.

[9]  R. Eckel,et al.  Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. , 1997, Circulation.

[10]  U. P. S. T. Force.  Screening for Obesity in Adults: Recommendations and Rationale , 2003, Annals of Internal Medicine.

[11]  Jeffrey M Slezak,et al.  Diagnosis of obesity by primary care physicians and impact on obesity management. , 2007, Mayo Clinic proceedings.

[12]  K. Stange,et al.  Direct observation of nutrition counseling in community family practice. , 1999, American journal of preventive medicine.

[13]  Jonathan L. Blitstein,et al.  Design and analysis of group-randomized trials: a review of recent methodological developments. , 2004, American journal of public health.

[14]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[15]  William W Eaton,et al.  Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. , 2003, American journal of epidemiology.

[16]  A. Tarlov,et al.  The relationship between patient income and physician discussion of health risk behaviors. , 1997, JAMA.

[17]  K. Greiner,et al.  Discussing Weight with Obese Primary Care Patients: Physician and Patient Perceptions , 2008, Journal of General Internal Medicine.

[18]  Treatment of Obesity in Adults.  Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. , 1998, Obesity research.

[19]  D. Galuska,et al.  Are health care professionals advising obese patients to lose weight? , 1999, JAMA.

[20]  S. Fowler,et al.  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. , 2002 .

[21]  M. Potter,et al.  Weight management: what patients want from their primary care physicians. , 2001, The Journal of family practice.

[22]  T. Marcy,et al.  Development and implementation of group medical visits at a family medicine center. , 2006, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[23]  T. Wadden,et al.  Obese women's perceptions of their physicians' weight management attitudes and practices. , 2000, Archives of family medicine.

[24]  M. Loureiro,et al.  Obesity, weight loss, and physician's advice. , 2006, Social science & medicine.

[25]  K. Morland,et al.  The use of an electronic medical record to improve documentation and treatment of obesity. , 2007, Family medicine.

[26]  Evangelos Evangelou,et al.  Intraclass correlation coefficients for cluster randomized trials in primary care: the cholesterol education and research trial (CEART). , 2005, Contemporary clinical trials.

[27]  F. Pi‐Sunyer,et al.  Medical Hazards of Obesity , 1993, Annals of Internal Medicine.

[28]  R. Kushner,et al.  Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. , 1995, Preventive medicine.

[29]  Victor J Stevens,et al.  Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. , 2003, JAMA.

[30]  D. Tate,et al.  Who reports receiving advice to lose weight? Results from a multistate survey. , 2000, Archives of internal medicine.

[31]  Abdullah Al Mamun,et al.  Obesity in Adulthood and Its Consequences for Life Expectancy: A Life-Table Analysis , 2003, Annals of Internal Medicine.

[32]  S. Flocke,et al.  Exercise, diet, and weight loss advice in the family medicine outpatient setting. , 2005, Family medicine.

[33]  R. Epstein,et al.  So much to do, so little time: care for the socially disadvantaged and the 15-minute visit. , 2008, Archives of internal medicine.

[34]  K. Treadway.  The future of primary care: sustaining relationships. , 2008, The New England journal of medicine.

[35]  R. Ross,et al.  Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. , 2002, The American journal of clinical nutrition.

[36]  Truls Østbye,et al.  Empathy goes a long way in weight loss discussions. , 2007, The Journal of family practice.

[37]  L. Gary Hart,et al.  Trends in professional advice to lose weight among obese adults, 1994 to 2000 , 2005, Journal of General Internal Medicine.

[38]  D. Bonds,et al.  Prevalence of nutrition and exercise counseling for patients with hypertension , 2004, Journal of General Internal Medicine.

[39]  Anson,et al.  DIET , LIFESTYLE , AND THE RISK OF TYPE 2 DIABETES MELLITUS IN WOMEN , 2001 .

[40]  T. Wadden,et al.  Primary care physicians' attitudes about obesity and its treatment. , 2003, Obesity research.

[41]  N. Milas,et al.  Long-Term Weight Loss and Changes in Blood Pressure: Results of the Trials of Hypertension Prevention, Phase II , 2001, Annals of Internal Medicine.

[42]  L. Weissfeld,et al.  Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics. , 2005, Preventive medicine.