Patient characteristics related to intensity of weight reduction care in a university medical clinic

Objective:To identify patient characteristics related to intensity of weight reduction care provided in a primary care practice. Design:Cross-sectional study linking data from a patient survey and data from medical records. Setting:Internal medicine housestaff clinic in an urban university hospital. Participants:321 outpatients who represented a systematic sample of all outpatients who had visited the clinic over one year. Measurements and main results:The patient population was largely black (86%) and female (65%). Most patients (54%) were overweight [body-mass index (BMI)>85th percentile for the United States by gender]. Intensity of care was defined by a composite scale: points were awarded for actions documented in the medical chart or recalled by the patient. Factors independently associated with a higher intensity of care among the 161 overweight patients were: BMI [odds ratio (OR)=1.13 per kg/m ²;95% confidence interval (95% CI)=1.04, 122; p=0.002], the patient’s self-perception of being overweight (OR=5.37; 95% CI=1.99, 14.46; p=0.001), and age of 64 years or younger (OR=2.48; 95% CI=1.12, 5.48; p=0.02). Race, gender, and presence of hypertension or hypercholesterolemia were not associated with greater intensity of care. Conclusions:Patients with hypertension and hypercholes-terolemia may be receiving suboptimal weight reduction care. Heightened awareness of being overweight may enbance the provision of weight reduction care. Prospective studies are required to confirm these findings. Received from the Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins Health Institutions, Baltimore, Maryland. Supported by the Pew Charitable Trusts and the Rockefeller Foundation Health of the Public Program. Computer analysis was supported by a grant from the National Center for Research Resources, National Institutes of Health, General Clinical Research Centers 5M01RR00035.