OBESITY: Weight Counseling by PCPs Found Lacking
By Todd Neale, Senior Staff Writer,
October 04, 2011
Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Note that this study of primary care visits documents that despite increases in the prevalence of obesity in the population, there were significant declines in the percentage of adult primary care visits with counseling for weight reduction, diet, and exercise.
Review
ORLANDO -- Even as rates of overweight and obesity rise, primary care physicians appear to be cutting back on weight counseling for their adult patients, researchers found.
From 1995 to 2008 -- when rates of overweight and obesity are estimated to have increased from 52% to 63% -- the percentage of primary care visits that included weight counseling dropped from 7.8% to 6.2% (OR 0.62, P<0.001), according to Chris Sciamanna, MD, MPH, of Penn State College of Medicine in Hershey, Pa.
The reduction was consistent in patients recognized by the physician to have hypertension, diabetes, or obesity, he reported at the Obesity Society meeting here.
During the same time period, there was not a drop-off in the percentage of visits that included tobacco counseling, which Sciamanna said indicates that one of the possible explanations for the reduction in weight counseling is a perception that it does not work.
To back that up, he pointed to a 2003 survey of primary care physicians that found that the treatment of obesity was rated as significantly less effective than therapies for nine out of 10 other chronic conditions.
"I think some of the problem is that we really don't know what works in primary care," Sciamanna said, adding that physicians need effective tools, including websites and programs, to guide the treatment of obese patients.
"Doctors really need to know what to say ... because these things are complicated and we're not trained to counsel," he said. "Unless you're going to change the way doctors are educated, we really need to know what exactly to say and what exactly to do."
In 2003, the U.S. Preventive Services Task Force recommended screening all adult patients for obesity and offering intensive counseling and behavioral interventions to promote weight loss for those who were obese.
The federal government has also set a Healthy People 2020 goal of increasing the proportion of obese-adult office visits that include counseling and education related to losing weight and living a healthy lifestyle.
But despite the guidance, previous studies have shown counseling rates to be low, Sciamanna said. To see if there's been an increase in recent years, he and his colleagues looked at data from the National Ambulatory Medical Care Survey, comparing 15,753 adult patients treated in 1995 to 1996 to 16,766 patients treated in 2007 and 2008.
The analysis was restricted to office-based visits to family physicians, general practitioners, and general internists.
As part of the study, physicians checked off services provided at each visit and what conditions each patient had.
After adjustment for patient and provider characteristics, the percentage of visits that included weight counseling fell by a relative 38% from the earlier to the later time period (OR 0.62, 95% CI 0.50 to 0.77), even for obese patients (from 39.9% to 29.9%).
There were similar trends for diet and exercise counseling as well.
Sciamanna noted some limitations of the analysis, including the uncertainty of the actual body mass index of the patients and the unclear definition of weight counseling as selected by the physicians.
In addition, he said, it is assumed that physicians under-reported the rate of obesity -- about 11% for both time periods.