National Patterns of Physician Activities Related to Obesity Management
Randall S. Stafford, MD, PhD;
John H. Farhat, MPH;
Bismruta Misra, MPH;
David A. Schoenfeld, PhD
Arch Fam Med. 2000;9:631-638.
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.
From the Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School (Dr Stafford and Mr Farhat and Ms Misra) and the Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Harvard School of Public Health (Dr Schoenfeld), Boston. The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.
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