title: Obesity perceptions and documentation among primary care clinicians at a rural academic health center.
abstract: BACKGROUND
  Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center.
  
  
  METHODS
  Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data.
  
  
  RESULTS
  Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity.
  
  
  CONCLUSIONS
  Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center.
authors.affiliation: Department of Internal Medicine, University at Iowa, 220 Hawkins Drive, Iowa City, IA 52242, United States.
authors.forename: Sohaib
authors.initials: S
authors.lastname: Aleem
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, United States; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH 03756, United States.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Lasky
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, United States.
authors.forename: W Blair
authors.initials: WB
authors.lastname: Brooks
authors.affiliation: Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, United States; Centers for Health and Aging, Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, United States; Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, United States; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH 03756, United States. Electronic address: john.batsis@gmail.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Batsis
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D019035:Rural Health Services / Q000706:statistics & numerical data*
keywords: Body mass index; Electronic health record; Obesity; Primary care; Survey