title: The time burden of overweight and obesity in primary care.
abstract: BACKGROUND
  Overweight and obesity are associated with many conditions treated in primary care. Our objectives were: 1) to determine the frequency of weight-related conditions in a national sample of outpatient visits in the United States; 2) to establish the percentage of diagnosis codes and visit codes attributable to overweight and obesity; and 3) to estimate time spent to address these conditions, including time attributable to overweight and obesity itself.
  
  
  METHODS
  We analyzed primary care visits from the 2005 and 2006 National Ambulatory Medical Care Survey (NAMCS) in the United States. Weight-related conditions included diabetes, hypertension, hyperlipidemia, obesity, cardiovascular disease, osteoarthritis, and low back pain. We used multivariable logistic regression to estimate an odds ratio for each weight-related condition, which we then converted to an attributable fraction (AF). The AF represents the percentage of diagnosis codes and visit codes attributable to excess weight for that condition. We then divided total visit time among all diagnoses and clinical items addressed at the primary care visit. Finally, to calculate the time attributable to overweight and obesity, we multiplied the AFs by the time spent on each weight-related condition.
  
  
  RESULTS
  The total number of clinical items (diagnoses + medications + tests + counseling) was estimated to be 7.6 per patient, of which 2.2 were weight-related. Of a total visit time of 21.77 minutes, time spent addressing weight-related conditions was 5.65 minutes (30%), including 1.75 minutes (8.0%) attributable to overweight and obesity.
  
  
  CONCLUSIONS
  Approximately 8% of time from primary care visits is attributable to overweight and obesity. This estimate is conservative because the NAMCS only allows for coding of three diagnoses addressed per visit. Estimates of the time burden of overweight and obesity provide data to prioritize weight management for prevention and treatment.
authors.affiliation: Division of General Internal Medicine and Center for Human Nutrition, University of Colorado School of Medicine, Address: Campus Box C-263, 13001 E, 17th Place, Aurora, Colorado 80045, USA. adam.tsai@ucdenver.edu
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tsai
authors.forename: Elmer D
authors.initials: ED
authors.lastname: Abbo
authors.forename: Lorraine G
authors.initials: LG
authors.lastname: Ogden
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D009767:Obesity, Morbid / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D016017:Odds Ratio; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D050177:Overweight / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000191:economics; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors; D014481:United States