title: A patient-centered decision rule for referral of patients to weight-loss programs.
abstract: BACKGROUND
  The obesity epidemic threatens to shorten life expectancy and reduce the quality of life for large segments of the population. The purpose of this study was to develop a decision rule for referral to a weight-loss program on the basis of the relationship between body mass index (BMI) and self-rated overall health.
  
  
  METHODS
  We employed a patient satisfaction survey of family medicine patients treated in Mayo Clinic in Rochester, Minnesota, linked with medical record information, to test the theory that, in primary care patients, BMI exhibits an inverse and independent relationship with overall self-rated health after adjusting for age, gender, marital status, and cigarette smoking. Interviews were linked to medical records for 679 adult patients.
  
  
  RESULTS
  Adjusting for age and other confounders using multiple logistic regression analysis revealed that overweight (BMI = 25-30 kg/m(2)) was not a risk factor for poor self-rated health and only BMI above 35 kg/m(2) was significantly related to poor overall health (adjusted odds ratio = 0.33, confidence interval = 0.17-0.64, P = .0012).
  
  
  CONCLUSIONS
  Quality improvement programs should monitor whether obesity is being addressed in clinical settings. A patient-centered decision rule for addressing obesity could involve referral of patients whose BMI is above 35 kg/m(2) to weight management programs, monitoring of patients whose BMI scores are between 30 and 35 kg/m(2), and encouragement of patients whose BMI is above 25 kg/m(2) to avoid weight gain.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55905, USA. rohrer.james@mayo.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Rohrer
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Merry
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.forename: Steven C
authors.initials: SC
authors.lastname: Adamson
authors.forename: Laurie
authors.initials: L
authors.lastname: Wilshusen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003661:Decision Support Techniques; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012307:Risk Factors; D012907:Smoking; D015431:Weight Loss