Obesity Prevention Counseling and Compliance in the U.S. for High Risk Groups

OBJECTIVE: Assess the frequency and determinants of obesity prevention counseling and compliance in the U.S. population at large as well as for subjects with obesity and high cholesterol. METHODS: Analyses of the National Health and Nutrition Examination Survey 2008 were conducted among adult subjects. Variables included demographic factors, weight status, self-reported obesity prevention counseling, and compliance. Multivariate logistic regression models were fit, accounting for complex sampling, to obtain odds ratios with 95% confidence intervals (OR, 95% CI) assessing factors associated with obesity prevention counseling and compliance. RESULTS: A total of 6914 subjects' observations were included; about 22% subjects were counseled to control their weight, 28% to increase physical activity and 24.4% to reduce their fat and caloric intake. Of subjects told to control their weight, 80.6% were doing so; of those counseled to increase physical activity 70.4% complied; and of those asked to reduce fat and caloric intake 81% complied. Among overweight or obese subjects N=4400) only 32.1% were counseled to control weight; 37.4% to increase physical activity; and 33.5% to reduce fat/caloric intake. A total of 42.6% of subjects with cholesterol self-reported status data (N=4029) had high cholesterol levels. Among them, 81.2% were counseled to reduce fatty food intake, 57.5% to control weight, and 68.3% to increase physical activity. Among subjects with high cholesterol , 82.4% of those counseled to reduce fat intake complied; 84.5% of those asked to control weight did so; and 75.2% of those told to increase physical activity complied. Logistic regression models showed that factors associated with counseling for weight control were age (OR 1.01, 95% CI 1.01, 1.02); African American (OR 1.75, 95% CI 1.38, 2.23), Mexican American (OR 1.27, 95% CI 1.04, 1.55), other ethnicity(OR 1.24, 95% CI 1.00, 1.55) (using Caucasians as reference group); higher income (OR 1.11, 95% CI 1.05, 1.18); and being overweight or obese (OR 10.0, 95% CI 7.6, 13.22). Similar results were found for increasing physical activity and reducing fat/calorie intake counseling, but, in addition, males were less likely to be counseled than females. Compliance with obesity prevention counseling was negatively associated with Mexican American ethnicity and male gender. CONCLUSIONS: Obesity prevention counseling is being neglected at physician visits for the population at large as well as for high risk groups such as overweight/obese subjects and those with hypercholesterolemia. A “reverse” disparity seems to be occurring, with ethnic minorities more likely to receive obesity prevention counseling than Caucasians.