Weight Management: What Patients Want from Their Primary Care Physicians

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Original Research

Weight Management: What Patients Want from Their Primary Care Physicians

J Fam Pract. 2001 June;50(6):513-518

References

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19. Levy PT, Williamson PS. Patient perceptions and weight loss in obese adults. J Fam Pract 1988;27:285-90.

20. Murphree D. Patient attitudes toward physician treatment of obesity. J Fam Pract 1994;39:45-48.

21. Logue E, Sutton K, Jarjoura D, Smucker W. Obesity management in primary care: assessment of readiness to change among 284 family practice patients. J Am Board Fam Pract 2000;13:164-71.

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Interventions Used by Physicians Who Helped Patients Lose Weight

Of the 206 patients in our study who were either obese or overweight (BMI >25), 37 (18%) said that their current physicians had helped them lose weight in the past. We did a stepwise logistic regression analysis to learn more about what physician behaviors were predictive of this outcome. The logistic regression models offered the variables in Table 1 and patient BMI as candidates for consideration of statistical significance, as well as the items listed in Table 4. Physicians given credit by obese or overweight patients for helping them to lose weight in the past were more likely to have referred patients to weight loss groups and programs (OR=9.9; 95% CI, 1.9-59.6), made exercise recommendations (OR=9.3; 95% CI, 2.7-35.7), and helped patients understand the risks of their weight to their health (OR=4.5; 95% CI, 1.3-15.4).

Discussion

Nearly all patients in this diverse primary care population who might benefit from weight loss believed that they should lose weight. Most indicated that diet and exercise were the best weight loss methods for them. Also, 35% of obese patients and 20% of overweight patients believed that referral to a weight loss program could help them lose weight. Obese and overweight patients were generally receptive to the involvement of their primary care physicians with their weight concerns.

Unfortunately, only a minority of obese and overweight patients said they had discussed weight with their physicians in the past. We found that physicians targeted their communication about weight to patients with higher BMIs and obesity-related comorbidities. Similar findings have been reported by others in recent years.^9,12,14 Although this selective approach may have merit, it may also ignore the larger population of obese and overweight patients who may be receptive to a physician’s help with these issues. Also, it raises the question of whether primary care physicians are neglecting their responsibility to address weight management with patients before comorbidities develop.

The most common weight loss approaches used by physicians for obese patients were: (1) telling their patients to lose weight (48%) and (2) not bringing up the subject of their weight (33%). By far the most common weight loss approach physicians used for overweight patients was not bringing up their weight (64%). Also, although some patients said they wanted to be told by their physicians to lose weight (39% of obese patients and 13% of overweight patients), many wanted a more comprehensive approach, including dietary advice, exercise recommendations, and help in setting realistic weight goals. These results suggest that even when primary care physicians address weight issues with obese and overweight patients the discussion is not as intensive as many patients would like.

The diversity of responses given by obese and overweight patients suggests that physicians will need to tailor their advice to the individual needs of patients. However, we found that the small number of obese and overweight patients who credited their physicians with helping them lose weight were more likely to have received a few specific interventions. In particular, these patients were significantly more likely to have been referred to weight loss groups or programs, to have received exercise recommendations, and to have been given insights into the risks of their weight to their health. These might be important features for primary care physicians to consider incorporating into their approach to weight loss with their obese and overweight patients.

Perhaps the most surprising finding is that 39% of patients with BMIs less than 25 thought they should lose weight. Although a relatively small number of these patients may benefit from weight loss because of an unusually high waist-to-hip ratio or certain comorbidities that could confer increased risk,¹⁷ it is unlikely that more than a few of them would benefit medically from weight loss. Thus, physicians may need to work individually with these non-overweight patients to dispel myths and help them feel happier with their current weight.

Primary care physicians generally agree that prevention, identification, and treatment of weight problems and its comorbidities should be within their scope of practice.^23,24 Lack of time, training, teaching materials, staff support, and adequate reimbursement have been cited as common reasons they fail to address these issues more often in clinical practice.²⁵ Also, some physicians may not bring up weight issues for fear of negative patient reactions—fears that may have merit in some cases.²⁶ However, our study shows that the vast majority of patients are willing and even eager to discuss weight with their current primary care physicians.

Physicians may also neglect to bring up weight-related issues because they are uncertain whether such a discussion will have a positive impact on the health of their patients. A recent study confirmed that many obese and overweight patients who are seen in primary care are not ready to make the lifestyle changes needed for sustained weight loss.²¹ However, other studies suggest that physician encouragement can increase a patient’s readiness to make important lifestyle changes over time.^27,28 Recent studies also suggest that a physician’s advice to exercise can significantly improve activity levels over a several-month period.²⁹