title: Secular trends in the diagnosis and treatment of obesity among US adults in the primary care setting.
abstract: Excess weight afflicts the majority of the US adult population. Research suggests that the role of primary care physicians in reducing overweight and obesity is essential; moreover, little is known about self-care of obesity. This report assessed the secular trends in the care of overweight and investigated the secular association between obesity with care of overweight in primary care and self-care of overweight. Cross-sectional evaluation of the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the Continuous NHANES (1999-2008) was employed; the total sample comprised 31,039 nonpregnant adults aged 20-90 years. The relationship between diagnosed overweight, and directed weight loss with time and obesity was assessed. Despite the combined secular increase in the prevalence of overweight and obesity (BMI >25.0 kg/m(2)) between 1994 and 2008 (56.1-69.1%), there was no secular change in the odds of being diagnosed overweight by a physician when adjusted for covariates; however, overweight and obese individuals were 40 and 42% less likely to self-diagnose as overweight, and 34 and 41% less likely to self-direct weight loss in 2008 compared to 1994, respectively. Physicians were also significantly less likely to direct weight loss for overweight and obese adults with weight-related comorbidities across time (P < 0.05). Thus, the surveillance of secular trends reveals that the likelihood of physician- and self-care of overweight decreased between 1994 and 2008 and further highlights the deficiencies in the management of excess weight.
authors.affiliation: Faculty of Health, School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.
authors.forename: Erika A
authors.initials: EA
authors.lastname: Yates
authors.forename: Alison K
authors.initials: AK
authors.lastname: Macpherson
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000639:trends; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010817:Physician-Patient Relations; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data* / Q000639:trends; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult