Weight loss counseling by health care providers

OBJECTIVES: This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients. METHODS: Data from the 1994 Connecticut Behavioral Risk Factor Surveillance System survey were analyzed to determine (1) the frequency of weight management counseling by health care providers of overweight adults with and without additional cardiovascular risk factors and (2) the current weight loss practices of overweight subjects. RESULTS: Only 29% of all overweight respondents and fewer than half with additional cardiovascular risk factors, reported that they had been counseled to lose weight. CONCLUSIONS: The findings suggest a need for more counseling of overweight persons, especially those with cardiovascular disease risk factors.     

National patterns of physician activities related to obesity management

CONTEXT: National physician practices related to the clinical recognition and management of obesity are unknown. OBJECTIVES: To estimate national patterns of office-based, obesity-related practices and to determine the independent predictors of these practices. DESIGN: Serial cross-sectional surveys of physician office visits. SETTING: Ambulatory medical care in the United States. PATIENTS: We analyzed 55,858 adult physician office visits sampled in the 1995-1996 National Ambulatory Medical Care Surveys. Data from the Third National Health and Nutrition Examination Surveys, 1988-1994 were used to assess and, then, adjust for the underreporting of obesity. MAIN OUTCOME MEASURES: Reporting of obesity at office visits and physician counseling for weight loss, exercise, and diet among patients identified as obese. RESULTS: Physicians reported obesity in only 8.6% of 1995-1996 National Ambulatory Medical Care Surveys visits. The 22.7% prevalence rate of the Third National Health and Nutrition Examination Surveys, 1988-1994 suggests that physicians reported obesity in only 38% of their obese patients. Among visits by patients identified as obese, physicians frequently provided counseling for weight loss (35.5%), exercise (32.8%), and diet (41.5%). Adjusted for population prevalence; however, each service was provided to no more than one quarter of all obese patients. While patients with obesity-related comorbidities were treated more aggressively, in these patients, weight loss counseling occurred at only 52% of the visits. CONCLUSIONS: Specific interventions to address obesity are infrequent in visits to US physicians. Obesity is underreported and interventions are only moderately likely among patients identified as obese, even for those with serious obesity-related comorbidities.     

Direct observation of nutrition counseling in community family practice

BACKGROUND: Despite the large potential of dietary changes to reduce morbidity and mortality, the frequency, time spent, and factors associated with nutrition counseling in primary care are not well studied. METHODS: In a cross-sectional study of 84 family physician practices in northeast Ohio, nutrition counseling was measured by direct observation on 2 days for all consecutive ambulatory visits. The frequency, time spent, and patient and visit characteristics associated with nutrition counseling were determined. RESULTS: Among 138 family physicians, only 6% included nutrition counseling in the majority (>50%) of patient encounters. Among 3475 consecutive outpatient visits in adults, nutrition counseling occurred in 24% of all patient visits, 17% of visits for acute illnesses, 30% of chronic illness visits, and 41% of well-care visits. The average time spent on nutrition counseling was 55 seconds, ranging from <20 seconds to >6 minutes. Nutrition counseling occurred in 45% of visits for diabetes, 25% of visits for cardiovascular disease, 31% of visits for hypertension, 26% of prenatal visits, and 33% of visits by obese patients (body mass index >30). Nutrition counseling was more likely to occur during visits by patients who were older or had diabetes mellitus, during visits for well care or chronic illness, and during longer visits. CONCLUSION: Despite considerable variability from physician to physician, nutrition counseling occurs in approximately one fourth of all office visits to family physicians. The observed efforts by family physicians to focus nutrition counseling on high-risk patients may increase its impact.     

Primary care of overweight children: the importance of parent weight and attitudes about overweight: a MetroNet study.

PURPOSE: The purpose of this study was to identify the association of parents' weight and attitude about their child's weight with the child's body mass index (BMI) status. DESIGN: Cross-sectional, clinic-based study in a practice-based research network. METHODS: One hundred seventy-one parents or adults accompanying children aged 5 to 17 years to a primary care visit in 4 family medicine centers completed a questionnaire. Parent/adult overweight status and attitudes were compared with child overweight status. RESULTS: Forty-eight percent of children were overweight or obese (BMI >or= the 85th percentile) as were 56% of mothers and 77% of fathers (BMI >or= 25 kg/m(2)). Child and parent overweight were significantly associated, as were mother overweight and beliefs about child overweight status. Children aged 5 to 13 years were more likely to be overweight than those aged >or=14 years. CONCLUSIONS: Parents of overweight children are often overweight and many do not recognize that their children are overweight. Suggestions are made for primary care physicians to engage parents of overweight children in family weight control efforts.     

Physician counseling of young adults with rapid weight gain: a retrospective cohort study

Background

The incidence of weight gain is highest during young adulthood. Our study aims to describe weight gain patterns among young adults and to evaluate physician recognition of and counseling for rapid weight gain.

Methods

This retrospective cohort study included patients ages 18-35 at an academic internal medicine clinic between 2004-2008. We conducted chart reviews to determine weight change over time, whether weight gain greater than 3 lbs/year was documented, whether counseling was provided, and whether patients became overweight. We categorized weight gain documentation by location on the problem list, encounter diagnosis, or note text. We categorized counseling as weight-specific or general diet and exercise counseling. We used Chi-square tests to evaluate the relationship between weight change over time and the following variables: gender, diagnosis of weight gain, and counseling for weight gain. Fisher's Exact test was used to test for an association between diagnosis and counseling category.

Results

The study included 365 patients. Weight gain was greater than 3 lbs/year for 24% (90/365) of patients, of whom 56 (15%) gained 3-5.9 lbs/year, and 34 (9%) gained more than 6 lbs/year. Among patients gaining more than 3 lbs/year, physicians documented weight gain as a problem in only 10% (9/90). Of the 9 patients for whom weight gain was documented, physicians provided weight-specific counseling in three, and general diet and exercise counseling in four. Of the 81 individuals with no documented diagnosis of weight gain, 63% had no documented counseling, but 34% received general diet and exercise counseling. Among patients with over 180 days of follow-up, 8% (10/126) became overweight.

Conclusions

Physicians infrequently recognize or counsel for weight gain among young adult patients. Improving identification of patients with rapid weight gain can provide an opportunity for tailored weight-related counseling.     

Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor

Despite evidence that weight loss improves the severity of coronary heart disease (CHD) risk factors, a direct association between weight loss and CHD incidence has not been demonstrated. In 1994-2001, the authors conducted an observational study of intentional weight loss as related to CHD incidence among patients recruited from a network of clinics in Israel who received nutritional counseling from a dietitian to support the medical recommendation to lose weight. Subjects were outpatients aged 50-75 years with a body mass index of > or =27 kg/m(2), without CHD or cancer but with at least one risk factor for CHD in addition to overweight. Outcomes were documented over 4 years by repeated weight measurements and by medical record verification. Among 1,669 patients, 224 (13.4%) incidents of CHD were recorded. For subjects who underwent at least 6 months of dietetic counseling, the risk-factor-adjusted odds ratio for CHD incidence associated with a weight loss of 4.5 kg (the median level of weight loss) was 0.57 (95% confidence interval: 0.39, 0.84). In this, the largest known study of its type reported to date, intentional weight loss from a 6-month diet predicted lower incidence of CHD over 4 years.     

Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics

BACKGROUND: Past research has surveyed primary care physicians (PCP) about their attitudes and practices towards obese patients, yet less is known about the patients receiving advice. METHODS: The Primary Care Weight Control Project (PCWC) enrolled 18 PCPs in a randomized clinical trial and asked 255 of their patients who were either overweight or obese at baseline about past weight control advice. RESULTS: At baseline, 66.4% of patients reported that their physician previously told them they were overweight. Body mass index (BMI) was a strong predictor of being identified as obese. While 65.1% received information on the health benefits of weight loss, only 36.6% of patients were ever given specific weight control advice, and 28.2% were advised to increase their physical activity. A history of type 2 diabetes, high cholesterol, or hypertension was associated with physician-delivered weight control advice. Stages of change and number of prior visits with the PCP were also associated with physician advice. CONCLUSIONS: Patients were more likely to receive education about weight loss than specific behavioral advice on how to lose weight. Physicians were more likely to provide weight control advice to their patients who had obesity-related comorbidities than to patients who were overweight or obese and without risk factors.     

Characteristics of adults with overweight and obesity who have not attempted weight loss in the prior 12 months

ObjectiveTo determine weight-related characteristics of adults with overweight or obesity who had not attempted weight loss in the prior 12 months.MethodsAdults from the obesity cohort of the PORTAL clinical data research network were randomly selected to complete a survey in 2015. It included topics of experiences with health care providers, weight history, and health-promoting behaviors.ResultsA total of 2811 adults completed the survey, of whom 24% reported not attempting weight loss in the previous 12 months. Controlling for sociodemographic characteristics and body mass index, respondents who reported that their health care provider never talked about weight were more likely to not attempt weight loss in the previous 12 months compared with respondents who reported providers frequently brought up weight (OR: 0.45; 95% CI: 0.24, 0.66). Respondents who perceived themselves as normal weight or underweight were 4.22 times more likely (95% CI: 3.53, 5.05) to not attempt weight loss compared with respondents who perceived themselves as overweight. Respondents who reported that they never tried to lose at least 10 lbs, ate 0−2 servings of fruits and vegetables daily, or engaged in 0−29 min of physical activity weekly were less likely to attempt weight loss.ConclusionsReceiving advice on weight loss from health care providers to improve awareness of overweight and obesity status may be important factors for a person’s weight management. Provider discussions about weight may be a strategy to motivate weight loss attempts.     

National Hospital Ambulatory Medical Care Survey: 2005 outpatient department summary

OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1995 to 2005 are also presented. METHODS: The data presented in this report were collected in the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to emergency and OPDs of nonfederal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. RESULTS: During 2005, an estimated 90.4 million visits were made to hospital OPDs in the United States, about 31.0 visits per 100 persons. Females (37.2 per 100 persons) had higher OPD visit rates than males (24.7 visits per 100 persons), and black or African-American persons (56.8 visits per 100 persons) had higher OPD visit rates than white persons (28.3 visits per 100 persons). Visit rates to OPD clinics for preventive care were highest for children under 1 year of age (43.1 per 100 persons). Almost one-half of OPD visits (46.1 percent) were made by patients with one or more chronic conditions. Hypertension was the most frequent chronic condition listed (19.7 percent). Visits with asthma declined with increasing age. From 1995 to 2005, the following visit characteristics changed: The visit rate for children under 15 years of age increased by 38%, the percentage of visits made by adults 18 years and over with depression indicated on the medical record increased by 48%; visits by adults with obesity, diabetes, and hypertension increased by 24%, 34%, and 43%, respectively; visits with counseling for tobacco use increased from 2.7 to 3.8 percent; visits with counseling for diet and nutrition increased from 9.4 to 15.7 percent; and visits with 6 or more medications prescribed or provided more than doubled, from 4.9 to 11.2 percent.