Research article
U.S. Primary Care Physicians' Diet-, Physical Activity–, and Weight-Related Care of Adult Patients

https://doi.org/10.1016/j.amepre.2011.03.017Get rights and content

Background

Overweight and obesity are substantial problems in the U.S., but few national studies exist on primary care physicians' (PCPs') clinical practices regarding overweight and obesity.

Purpose

To profile diet, physical activity, and weight control practice patterns of PCPs who treat adults.

Methods

A nationally representative survey of 1211 PCPs sampled from the American Medical Association's Masterfile was conducted in 2008 and analyzed in 2010. Outcomes included PCPs' assessment, counseling, referral, and follow-up of diet, physical activity, and weight control in adult patients with and without chronic disease and PCPs' use of pharmacologic treatments and surgical referrals for overweight and obesity.

Results

The survey response rate was 64.5%. Half of PCPs (49%) reported recording BMI regularly. Fewer than 50% reported always providing specific guidance on diet, physical activity, or weight control. Regardless of patients' chronic disease status, <10% of PCPs always referred patients for further evaluation/management and <22% reported always systematically tracking patients over time concerning weight or weight-related behaviors. Overall, PCPs were more likely to counsel on physical activity than on diet or weight control (p's<0.05). More than 70% of PCPs reported ever using pharmacologic treatments to treat overweight and 86% had referred for obesity-related surgery.

Conclusions

PCPs' assessment and behavioral management of overweight and obesity in adults is at a low level relative to the magnitude of the problem in the U.S. Further research is needed to understand barriers to providing care and to improve physician engagement in tracking and managing healthy lifestyles in U.S. adults.

Introduction

Managing obesity is one of the biggest health challenges facing healthcare providers today, as almost 70% of the adult population in the U.S. is now considered overweight or obese.1 Obesity increases risks of many medical conditions, including heart disease, diabetes, hypertension, stroke, and some cancers, as well as total morbidity and mortality.2, 3 Poor diet and physical inactivity increase the risk of obesity. Yet data show that approximately 60% of the U.S. adult population gets insufficient regular physical activity4 and that few Americans are consuming diets consistent with guidelines.5 To combat the epidemic of overweight and obesity, research on clinical practices related to “energy balance” (i.e., regulating energy intake [diet] and expenditure [physical activity] for healthy weight) has recently increased.2, 3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20

Research consistently documents that physician recommendations have a strong influence on individual health behaviors, and that physicians are an important source of information on preventive healthcare.14, 17 Evidence also suggests that physician recommendations are associated with patient efforts to increase physical activity8 and to lose weight.11 Further, current clinical guidelines support the need for healthcare providers to identify and treat overweight/obesity.3 However, studies that have examined primary care physicians' (PCPs') counseling practices regarding preventive care show patterns of relatively low emphasis on general prevention and on weight control, nutrition, or exercise counseling.6, 7, 9, 10, 12, 13, 15, 16, 18, 20 These data suggest a need to better understand physicians' energy balance clinical practices, such as counseling for diet, physical activity, and weight control, particularly given their relationship to disease burden.

To date, no national U.S. surveys have comprehensively examined PCPs' assessment, counseling, and follow-up of patients' diet, physical activity, and weight. To address these gaps, the National Cancer Institute (NCI) of the NIH developed the National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP), with cosponsorship from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute on Diabetes and Digestive and Kidney Diseases, the NIH Office of Behavioral and Social Sciences Research, and the CDC. This survey is the first to specifically examine four primary care specialties and to address differences in practice among clinicians treating adults with and without weight-related chronic illness and clinicians treating children. Given major recent health policy changes and the shifting healthcare landscape, this survey provides baseline information to better understand the influence of healthcare reform policies. For example, screening for overweight and obesity is a public health priority and is a Healthy People 2020 objective.21 This survey will inform this objective and better identify subgroups of physicians who could be targets for interventions to increase routine energy balance clinical practices.

The overall goal was to obtain nationally representative data on PCPs' use of energy balance clinical practices, defined as risk-assessment, counseling, follow-up, and referral patterns, and to identify characteristics of physicians who routinely incorporate these practices in patient care.

Section snippets

Sample Design

The EB-PCP survey target population was non-federal, office-based, actively practicing PCPs in the U.S. Physicians were selected from the following primary care specialties: family practice (FP); internal medicine (IM); obstetrics/gynecology (OB/GYN); and pediatrics (PEDS). A systematic stratified sample of PCPs was obtained using the American Medical Association's (AMA) Physician Masterfile as the sampling frame. The Masterfile contains demographic and practice-related data on all allopathic

Results

The response rate for the entire EB-PCP survey was 64.5%. For the adult-focused questionnaire, response rates by specialty were: IM=63.0%, OB/GYN=66.1%, FP=64.2%. The cooperation rate (excluding PCPs listed as “no-contact” by the AMA and those for whom we did not have valid contact information) was 69.8%. The response and cooperation rates were calculated using the American Association for Public Opinion Research RR3 and COOPR3 formulas.27 The majority of respondents were non-Hispanic white,

Discussion

This study provides nationally representative data describing energy balance clinical practices among U.S. PCPs regarding their adult patients' diet, physical activity, and weight control. Results suggest that PCPs' energy balance clinical practice is fairly low and needs improvement. While the majority of PCPs report regularly assessing weight and height, less than half are converting that information into BMI. Similarly, while most PCPs report providing some kind of counseling, less than half

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