title: Direct observation of weight counselling in primary care: alignment with clinical guidelines.
abstract: Primary care physicians provide care to a disproportionate number of overweight and obese patients and are uniquely positioned to help patients manage their weight in the context of a continuity relationship. The US National Heart, Lung and Blood Institute (NHLBI) developed evidence-based guidelines for the effective and efficient care of overweight/obese patients, but little is known about the use of these guidelines in practice. To determine the content of weight discussions and assess the elements of the NHLBI guidelines that were accomplished, office visits of 544 adult, overweight/obese patients to 28 primary care physicians were observed and audio recorded. Associations between type of weight management discussion and patient, physician and visit characteristics were examined. Fifty per cent (n = 270) of visits included weight discussions; 47% and 38% included use of at least one NHLBI assessment or treatment element during discussions about weight, respectively. Only 35% (n = 193) of discussions included an assessment and treatment strategy; none included all NHLBI-recommended elements. Overall, adherence to guidelines was poor, particularly with regard to reporting body mass index to the patient, measuring waist circumference and setting realistic weight loss goals. Weight discussions did not clearly vary by the patient, physician or visit characteristics examined. These findings suggest opportunities to develop and further tailor resources for improved physician training in patient weight management communication and treatment techniques that are both consistent with current standards for effective, evidence-based care and efficient enough for routine use during busy primary care visits.
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Antognoli
authors.forename: K J
authors.initials: KJ
authors.lastname: Smith
authors.forename: M J
authors.initials: MJ
authors.lastname: Mason
authors.forename: B R
authors.initials: BR
authors.lastname: Milliner
authors.forename: E M
authors.initials: EM
authors.lastname: Davis
authors.forename: S
authors.initials: S
authors.lastname: Harris-Haywood
authors.forename: E
authors.initials: E
authors.lastname: Seeholzer
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.forename: S A
authors.initials: SA
authors.lastname: Flocke
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000628:therapy*; D011320:Primary Health Care; D015431:Weight Loss
keywords: Guidelines; obesity; provider-patient communication; weight management
references.citation: Am J Prev Med. 1999 Oct;17(3):207-10
references.pmid: 10987637
references.citation: Prev Med. 2008 Dec;47(6):587-92
references.pmid: 18851991
references.citation: Patient Educ Couns. 2011 Nov;85(2):e8-15
references.pmid: 21183305
references.citation: Int J Qual Health Care. 1999 Jun;11(3):187-92
references.pmid: 10435838
references.citation: Obes Res. 2004 Sep;12(9):1426-34
references.pmid: 15483207
references.citation: Prev Med. 2004 Jun;38(6):819-27
references.pmid: 15193904
references.citation: Clin Obes. 2011 Apr;1(2-3):99-109
references.pmid: 25585575
references.citation: Prev Med. 2008 Oct;47(4):394-7
references.pmid: 18598712
references.citation: J Fam Pract. 2001 Jun;50(6):513-8
references.pmid: 11401737
references.citation: Mayo Clin Proc. 2007 Aug;82(8):927-32
references.pmid: 17673060
references.citation: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003818
references.pmid: 15846683
references.citation: BMC Health Serv Res. 2009 Dec 16;9:236
references.pmid: 20015391
references.citation: J Fam Pract. 1994 Feb;38(2):166-71
references.pmid: 8308509
references.citation: Obes Res. 1995 Sep;3 Suppl 2:211s-216s
references.pmid: 8581779
references.citation: Obesity (Silver Spring). 2006 Mar;14(3):373-6
references.pmid: 16648606
references.citation: Obes Res. 2001 Nov;9 Suppl 4:302S-311S
references.pmid: 11707558
references.citation: Fam Med. 2005 Jun;37(6):415-21
references.pmid: 15933914
references.citation: J Fam Pract. 2001 Mar;50(3):211-6
references.pmid: 11252208
references.citation: Am J Epidemiol. 2008 Jun 15;167(12):1465-75
references.pmid: 18417494
references.citation: Obes Res. 2003 May;11(5):641-52
references.pmid: 12740454
references.citation: Am J Prev Med. 2010 Oct;39(4):321-8
references.pmid: 20837282
references.citation: Obes Res. 2003 Oct;11(10):1168-77
references.pmid: 14569041
references.citation: Am J Prev Med. 2009 Jan;36(1):70-3
references.pmid: 18976879
references.citation: Am J Prev Med. 2002 Oct;23(3):174-9
references.pmid: 12350449
references.citation: Prev Med. 2004 Feb;38(2):198-202
references.pmid: 14715212
references.citation: Patient Educ Couns. 2011 Jan;82(1):123-9
references.pmid: 20303691
references.citation: Arch Intern Med. 2000 Aug 14-28;160(15):2334-9
references.pmid: 10927731
references.citation: J Gen Intern Med. 2008 May;23(5):581-7
references.pmid: 18322760
references.citation: Obes Res. 1998 Sep;6 Suppl 2:51S-209S
references.pmid: 9813653
references.citation: J Am Board Fam Med. 2009 Mar-Apr;22(2):115-22
references.pmid: 19264934
references.citation: J Insur Med. 2008;40(1):26-33
references.pmid: 18924364
references.citation: Obes Res Clin Pract. 2014 Mar-Apr;8(2):e123-30
references.pmid: 24743007
references.citation: Am J Prev Med. 2001 Oct;21(3):189-96
references.pmid: 11567839
references.citation: Int J Obes Relat Metab Disord. 1992 Jun;16(6):397-415
references.pmid: 1322866
references.citation: World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
references.pmid: 11234459
references.citation: Prev Med. 2004 Sep;39(3):612-6
references.pmid: 15313102
references.citation: J Am Board Fam Med. 2011 Jan-Feb;24(1):6-15
references.pmid: 21209339
references.citation: Diabetes Educ. 2006 Jul-Aug;32(4):557-61
references.pmid: 16873593
references.citation: Prev Med. 2009 Dec;49(6):482-6
references.pmid: 19786045