Differences in Obesity Management Among Physicians

Abstract

Despite the strong recommendations of guidelines, intensive obesity management is not offered to all obese patients. This study aimed to examine differences in obesity management between primary care physicians (PCPs) and non-PCPs. A cross-sectional study was performed using the 2006-2007 National Ambulatory Medical Care Survey. Adults (age ≥20 years) with obesity (body mass index (BMI)≥30 kg/m(2) or obesity diagnosis using International Classification of Diseases, Ninth Revision, Clinical Modification code 278) were included in the study cohort. A multivariate logistic regression model was constructed to examine differences between PCPs and non-PCPs (primary independent variable) for obesity management (dependent variable) while controlling for predisposing, enabling, and need characteristics per Anderson's behavioral model. In all, 32.66% of 214 million visits by obese patients in 2006-2007 resulted in obesity management. PCPs were 2.38 times more likely to provide obesity management compared to non-PCPs (odds ratio [OR]=2.37; 95% confidence interval [CI]: 1.69, 3.36). Patients who had preventive visits (OR=2.23; 95% CI: 1.50, 3.32) and chronic visits (OR=1.93; 95% CI: 1.46, 2.55) were more likely to receive obesity management than patients who had acute visits. More time spent with physician, more comorbid conditions, and BMI ≥ 40 significantly increased the likelihood of receiving obesity management, while older age and smoking reduced the likelihood of receiving obesity management. Only one third of ambulatory care visits in 2006-2007 resulted in obesity management. A difference in obesity management was noted between PCPs and non-PCPs. Future research should aim to identify the reasons for these observed differences, ensure equitable access, and address the undertreatment of obesity.

Do pediatric gastroenterology doctors address pediatric obesity?

“…Similar results have been previously reported in the adult population. Mehta et al 8 reported that less than one-third of preventive ambulatory visits in an obese adult population resulted in obesity management.…”

Understanding health policy to improve primary care management of obesity

“…PCPs recognize the priorities and issues that accompany treating obese and overweight individuals, such as sufficient time for educating and counseling patients. PCPs need a minimum of 20–30 minutes to spend with obese patients especially those with multiple co-morbidities 41 instead of the usual 10–15 minutes for an office visit. In other words, practice guidelines suggest specific interventions for this population require more time - even for follow up visits 42 .…”