Only a quarter of U.S. primary care physicians surveyed are doing a thorough job of helping patients achieve and maintain a healthy weight, finds a study in the American Journal of Health Promotion.
"We found that most primary care practices have few resources for supporting efforts to assess and counsel patients about diet, exercise and weight control," said lead author Carrie Klabunde, Ph.D., of the cancer control and population sciences division of the National Cancer Institute.
A random sample of 1,740 U.S. physicians participated in the study. Each participant completed two sequential questionnaires, one about their work with patients and one about their practice's resources. 26 percent of the participating physicians reported closely following established guidelines for what the authors call "energy balance care." Such guideline-based care would include regular assessment of BMI, counseling on nutrition, physical activity or weight control, and systematic tracking of patients' progress with weight issues over time.
The survey group included office-based family physicians or general internists, obstetrician/gynecologists and pediatricians. Striking specialty differences emerged, with comprehensive weight management services being most commonly offered by pediatricians (40.1 percent) and least often by obstetricians/gynecologist (8.4 percent).
Practices located in the Southeast and in smaller cities or rural areas were less likely to provide comprehensive services than ones in the Northeast or in larger cities. Female physicians and non-white physicians more often provided comprehensive services than males and whites did.
Klabunde noted that the availability of nonphysician staff such as dieticians, nutritionists or health educators and the use of full electronic health records (EHRs) and reminders—which support comprehensive services—were especially rare. In addition, the study showed that practices that billed for energy balance services were more likely to provide such counseling and to routinely track patients' progress, as compared to those that didn't bill for the services.
When a primary care physician does seriously encourage patients to control their weight, Klabunde said, their support can "serve as an important prompt for overweight or inactive individuals to adopt better habits."
Cary Wing, Ed.D., a fellow of the American College of Sports Medicine noted that the study showed that there is value in practices using EHRs and in having a designated "prevention champion." The study's results support an emphasis upon primary care physicians embracing "a team approach that leads to a referral pathway to community resources and for follow up by other health and wellness providers," she added.
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