Obesity Evaluation and Intervention During Family Medicine Well Visits
Obesity Evaluation and Intervention During Family Medicine Well Visits
Purpose: The purpose of this study was to determine the extent that primary care providers assess overweight and obesity and offer treatment strategies during well visits in a family medicine setting.
Methods: This was a cross-sectional study of 553 consecutive patients who presented for family medicine well visits. Patient charts were reviewed for documentation of body mass index (BMI) and patient education regarding weight, exercise, and diet.
Results: BMI was calculated for 63.5% of adults at the well visit. For patients who were overweight or obese (BMI greater than 25), 48.9% received education on weight, 50.2% on diet, and 41% on exercise. Adults who had BMI calculated were also more likely to receive weight-related education (P < .001). Although height and weight were measured for most of the children and adolescents, their BMI-for-age was not calculated and they were unlikely to receive weight-related education.
Conclusions: Training staff to measure and record BMI is a useful prompt for the physician to discuss overweight. To address weight during critical periods of development, children and adolescents need to have growth monitored with standardized tools.
Obesity is a growing epidemic in the United States that increases mortality and aggravates common medical conditions. Approximately 32% of adults in the United States, more than 60 million, are classified as obese as defined by BMI greater than 30. In adults, excess weight increases the risk of many chronic diseases, including heart disease, hypertension, diabetes, cancer, stroke, and osteoarthritis. Overweight in children and adolescents is defined as at or above the 95th percentile using sex- and age-specific growth charts. In 2003 to 2004, 17.1% of children and adolescents were overweight.
The current obesity epidemic has significant future implications to our health care system. It is estimated that health care expenditures related to obesity and overweight in adults are approximately $117 billion each year. Given the number of patients affected, the comorbid health implications, and the economic impact, primary care providers have been urged to place significant emphasis on the diagnosis and treatment of obesity during preventive health physical examinations. It is estimated that every month, primary care physicians see 11.3% of the US population. This provides an opportunity for intervention. Orzano and Scott reviewed recommendations from many scientific bodies addressing obesity in adults. They concluded that clinicians should manage obesity as a chronic relapsing condition and recommended patient education strategies to manage overweight and obese adult patients. The Institute of Medicine report, Preventing Childhood Obesity: Health in the Balance, recommends health professionals to routinely track BMI and to offer patients evidence-based guidance on weight control.
Measuring BMI is an effective measure for overweight and obesity; it is considered to be reliable, inexpensive, and quick. Even with the recommendations to identify and treat overweight and obesity, the prevalence of undiagnosed obesity in currently obese US adults is 22.9%. The high rate of undiagnosed obesity may be explained by the fact that, despite the availability and ease of measuring BMI, research has shown that it is frequently not used. Even when a formal diagnosis of obesity is made, clinicians may not provide patients with advice regarding weight loss. One study of obese patients seeking medical help for comorbid conditions found that only 27% to 42% were advised by their primary care physician to lose weight. In a national study of 12,835 adults classified as obese, only 42% reported that their health care provider advised them to lose weight.
The purpose of this study was to determine the extent that primary care providers assess overweight and obesity and document treatment strategies in a family medicine setting during well visits. Review of medical records provided data to assess the use of BMI for adults and BMI-for-age for children and allowed examination of the documentation of patient education concerning body weight, diet, and exercise.
Purpose: The purpose of this study was to determine the extent that primary care providers assess overweight and obesity and offer treatment strategies during well visits in a family medicine setting.
Methods: This was a cross-sectional study of 553 consecutive patients who presented for family medicine well visits. Patient charts were reviewed for documentation of body mass index (BMI) and patient education regarding weight, exercise, and diet.
Results: BMI was calculated for 63.5% of adults at the well visit. For patients who were overweight or obese (BMI greater than 25), 48.9% received education on weight, 50.2% on diet, and 41% on exercise. Adults who had BMI calculated were also more likely to receive weight-related education (P < .001). Although height and weight were measured for most of the children and adolescents, their BMI-for-age was not calculated and they were unlikely to receive weight-related education.
Conclusions: Training staff to measure and record BMI is a useful prompt for the physician to discuss overweight. To address weight during critical periods of development, children and adolescents need to have growth monitored with standardized tools.
Obesity is a growing epidemic in the United States that increases mortality and aggravates common medical conditions. Approximately 32% of adults in the United States, more than 60 million, are classified as obese as defined by BMI greater than 30. In adults, excess weight increases the risk of many chronic diseases, including heart disease, hypertension, diabetes, cancer, stroke, and osteoarthritis. Overweight in children and adolescents is defined as at or above the 95th percentile using sex- and age-specific growth charts. In 2003 to 2004, 17.1% of children and adolescents were overweight.
The current obesity epidemic has significant future implications to our health care system. It is estimated that health care expenditures related to obesity and overweight in adults are approximately $117 billion each year. Given the number of patients affected, the comorbid health implications, and the economic impact, primary care providers have been urged to place significant emphasis on the diagnosis and treatment of obesity during preventive health physical examinations. It is estimated that every month, primary care physicians see 11.3% of the US population. This provides an opportunity for intervention. Orzano and Scott reviewed recommendations from many scientific bodies addressing obesity in adults. They concluded that clinicians should manage obesity as a chronic relapsing condition and recommended patient education strategies to manage overweight and obese adult patients. The Institute of Medicine report, Preventing Childhood Obesity: Health in the Balance, recommends health professionals to routinely track BMI and to offer patients evidence-based guidance on weight control.
Measuring BMI is an effective measure for overweight and obesity; it is considered to be reliable, inexpensive, and quick. Even with the recommendations to identify and treat overweight and obesity, the prevalence of undiagnosed obesity in currently obese US adults is 22.9%. The high rate of undiagnosed obesity may be explained by the fact that, despite the availability and ease of measuring BMI, research has shown that it is frequently not used. Even when a formal diagnosis of obesity is made, clinicians may not provide patients with advice regarding weight loss. One study of obese patients seeking medical help for comorbid conditions found that only 27% to 42% were advised by their primary care physician to lose weight. In a national study of 12,835 adults classified as obese, only 42% reported that their health care provider advised them to lose weight.
The purpose of this study was to determine the extent that primary care providers assess overweight and obesity and document treatment strategies in a family medicine setting during well visits. Review of medical records provided data to assess the use of BMI for adults and BMI-for-age for children and allowed examination of the documentation of patient education concerning body weight, diet, and exercise.
