Assessment and management of adult obesity in an ambulatory primary care practice

Purpose: The purpose of this project was to describe primary care physician adherence to National Heart Lung and Blood Institute (NHLBI) Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (1998), and to explore patient characteristics associated with physician assessment and management behaviors. Patient characteristics included age, sex, race, BMI, associated disease risk, and Medicaid coverage. Methods: A chart abstraction of 100 randomly selected adult patients with at least one visit to a particular hospital-affiliated primary care practice during a 12-month period was completed. Patients were not pregnant during the year of review, and had a Body Mass Index of 25 or greater. The Physician Obesity Guideline Behavior Scale was developed and validated to score physician obesity assessment and management behavior as recorded in the patient chart. Results: Only 25% of clinically overweight or obese adult patients had actually been diagnosed as such. All patients had a weight/height recorded in the chart and 60% included a BMI. The majority of patients did not receive any dietary (72%) or physical activity (69%) management. When dietary management was introduced, those patients received either information (68%) or a goal (32%), and none received a goal with an accompanying plan. In cases where physical activity management was introduced, patients received a goal (52%) or information (39%), with few (10%) receiving a goal with accompanying plan. Preliminary findings suggest that physician assessment and management behaviors vary by patient characteristics.