From the University of Florida (Dr. Tucker, Ms. Ukonu, Ms. Kang, Ms. Good), Gainesville, FL; the University of Florida–Jacksonville (Dr. Shah, Dr. Bilello), Jacksonville, FL; and Ball State University (Dr. Arthur), Muncie, IN.
- Objective: To assess primary care physicians’ practices, knowledge, and beliefs regarding their efforts to promote healthy lifestyles and weight management among their patients.
- Methods: Study participants consisted of 25 primary care physicians from a regional primary care practice-based research network that includes 37 university-affiliated patient-centered medical homes and 2 nearby unaffiliated primary care sites. Participating physicians completed an online modified version of the Physician Survey of Practices on Diet, Physical Activity, and Weight Control–Adult Questionnaire.
- Results: The majority (88%) of participating physicians strongly believed it was their responsibility to promote a healthy diet, physical activity, and healthy weight loss and weight maintenance among patients. The 3 most commonly endorsed barriers were (a) not enough time, (b) minimal patient interest in improving his/her weight, and (c) lack of adequate weight-loss referral resources. The top 3 physician-perceived practice improvements that would be helpful with these practices were (a) better tools to communicate diet, physical activity, or weight problems to patients or family; (b) better mechanisms to connect patients to weight-loss referral resources; and (c) better counseling tools to guide patients regarding lifestyle modifications. 76% of the participating physicians correctly identified the BMI cutoff ranges for adult obesity, but only 32% did so for childhood obesity.
- Conclusion: It is important to provide primary care physicians with knowledge, effective tools, and resources to promote healthy lifestyles and weight loss and weight management among their patients.
Key words: obesity; primary care physicians; weight loss; weight management.
More than two-thirds of adults in the United States are overweight, with approximately 35% considered obese (defined as a body mass index ≥ 30) . Obesity is associated with many of the leading causes of death in the United States (ie, diabetes, heart disease, stroke, and some types of cancer) and with poor mental health outcomes and reduced quality of life . Racial/ethnic minorities and individuals with low incomes are disproportionately impacted by obesity and obesity-related diseases and negative health outcomes [3–5].
The US Preventive Services Task Force (USPSTF) recommends screening for obesity and intensive behavioral counseling, which are often the responsibilities of primary care providers . Despite these recommendations, research suggests that primary care providers rarely screen their patients for obesity or refer them for intensive behavioral counseling despite evidence that doing so would improve patient health outcomes [5–7]. Lack of time to address weight issues during clinical visits, lack of training in weight management counseling, and lack of availability of intensive weight loss programs to which they can refer their patients are some of the reasons cited for not counseling patients about weight management .
Primary care providers deliver more hours of patient care than other providers, yet these providers have been unable to deliver medical interventions capable of producing even modest weight loss . Obesity treatment options delivered in primary care settings have limited success, likely due to the low intensity of these treatment options. Many studies have shown that most obesity treatments in health care settings typically consist of scheduled monthly or quarterly visits that are 10 to 15 minutes in duration , despite evidence that more intense treatments are needed. Specifically, a systematic review of the obesity treatment literature performed by the USPSTF revealed that high-intensity, multicomponent behavioral interventions that include face-to-face counseling on diet and physical activity and behavioral therapy more than once a month for 3 months are needed to produce significant weight loss (8–15 lb) among adult patients in primary care settings .