title: A silent response to the obesity epidemic: decline in US physician weight counseling.
abstract: BACKGROUND
  Guidelines recommend that physicians screen all adults for obesity and offer an intensive counseling and behavioral interventions for weight loss for obese adults. Current trends of weight-related counseling are unknown in the setting of the US obesity epidemic.
  
  
  OBJECTIVE
  To describe primary care physician (PCP) weight-related counseling, comparing counseling rates in 1995-1996 and 2007-2008.
  
  
  METHODS
  Data analysis of outpatient PCP visits in 1995-1996 and 2007-2008, as reported in the National Ambulatory Medical Care Survey.
  
  
  METHODS
  A total of 32,519 adult primary care visits with PCPs.
  
  
  METHODS
  Rates of counseling for weight, diet, exercise, and a composite variable, weight-related counseling (defined as counseling for weight, diet, or exercise) between survey years. Adjusted analyses controlled for patient and visit characteristics.
  
  
  RESULTS
  Weight counseling declined from 7.8% of visits in 1995-1996 to 6.2% of visits in 2007-2008 [adjusted odds ratios, 0.64; 95% confidence intervals, 0.53, 0.79]. Rates of receipt of diet, exercise, and weight-related counseling similarly declined. Greater declines in odds of weight-counseling receipt were observed among those with hypertension (47%), diabetes (59%), and obesity (41%), patients who stand the most to gain from losing weight.
  
  
  CONCLUSIONS
  Rates of weight counseling in primary care have significantly declined despite increased rates of overweight and obesity in the United States. Further, these declines are even more marked in patients with obesity and weight-related comorbidities, despite expectations to provide such care by both patients and policymakers. These findings have implications for determining deliverable, novel ways to engage PCPs in addressing the obesity epidemic.
authors.affiliation: Penn State Hershey Medical Center and College of Medicine, Hershey, PA 17033, USA. jkraschnewski@hmc.psu.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kraschnewski
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Sciamanna
authors.forename: Heather L
authors.initials: HL
authors.lastname: Stuckey
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Hwang
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Sherwood
authors.forename: Harriet B
authors.initials: HB
authors.lastname: Nembhard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D015897:Comorbidity; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology