Weight Management: What Patients Want from Their Primary Care Physicians

,

Original Research

Weight Management: What Patients Want from Their Primary Care Physicians

J Fam Pract. 2001 June;50(6):513-518

By

Michael B. Potter, MD

References

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OBJECTIVE: We wanted to determine the weight management experiences of patients in primary care, and what those patients want from their physicians.

STUDY DESIGN: Patients completed a survey in a primary care waiting room. Afterward they were measured for body mass index (BMI).

POPULATION: A total of 410 consecutive adult patients in 2 primary care practices at the University of California, San Francisco, were approached, and 366 (89%) completed the survey.

OUTCOMES: measured The primary outcomes were patient attitudes about weight loss, previous weight management experiences with their current physicians, and future preferences for weight management within the primary care relationship.

RESULTS: Ninety-seven percent of the obese patients (BMI >30), 84% of the overweight patients (BMI=25-30), and 39% of the non-overweight patients (BMI <25) thought they needed to lose weight. Forty-nine percent of the obese patients, 24% of the overweight patients, and 12% of the non-overweight patients had discussed weight with their current physicians. The types of weight management assistance that patients most wanted from their physicians were: (1) dietary advice, (2) help with setting realistic weight goals, and (3) exercise recommendations.

CONCLUSIONS: Although most patients believe they should lose weight, this is often not discussed during office visits. Most patients (especially those who are overweight or obese) want more help with weight management than they are getting from their primary care physicians.

Obesity is a common condition with associated risks of morbidity and mortality.^1,2 Recent studies suggest that rates of obesity and overweight are increasing in the United States.^3,4 Primary care physicians are struggling to incorporate weight management issues into their daily practices and often do not find the time to discuss this issue with their patients.^5-14 In recent years, obesity experts have developed guidelines to help physicians assist their obese patients with losing weight.^15-18 As primary care physicians look for ways to implement these guidelines with positive results, an understanding of patients’ weight management experiences and expectations in the physician-patient setting will be helpful. Unfortunately, few studies have addressed this topic.^19-21 With this study, we hoped to gain greater understanding of weight management issues from the patient’s point of view.

Methods

Research Environment

Two primary care practices in San Francisco were used as the study settings; both are affiliated with the University of California, San Francisco (UCSF): (1) the UCSF Medical Group at Parnassus Heights (which included 5 family physicians and 2 general internists), and (2) the UCSF Medical Group at Lakeshore (which included 4 family physicians and 1 general internist). Approximately two thirds of the patients in these practices had managed care insurance; 10% had Medicare; and 10% had Medicaid. The remaining patients paid for health care with other forms of fee-for-service reimbursement.

Sample Selection

During June and July 1997, we approached 214 adult patients at Parnassus Heights and 196 patients at Lakeshore to ask them to participate in our study. These 410 participants were drawn from consecutive samples of patients who were in the waiting room for a primary care visit. Pregnant patients, those younger than 18 years, and those who could not read English were excluded from the survey. We enrolled 366 (89%) of the patients approached.

Research Instrument

The participants completed an anonymous survey containing 15 general questions that required either yes or no responses or a selection from a list of choices. Only patients reporting that they needed to lose weight were asked how their weight affects them, their weight loss goals, and the role of their primary care physicians in helping them achieve these goals. However, all patients were asked if they had discussed their weight with their physicians in the past and whether they would feel comfortable discussing it with them in the future. Also, all patients were asked to describe the interventions used by their physicians in the past and those they would like to receive in the future. Finally, all patients were asked to provide demographic information and comorbidities. They were then directed to remove their shoes and coats and had weight and height recorded on a calibrated scale.

Statistical Analyses

We used the patients’ measurements to calculate body mass index (BMI=weight in kg/height in m²). The patients were then divided into 3 groups: those who were not overweight (BMI <25), those who were overweight (BMI=25-30), and those who were obese (BMI >30). The chi-square statistic was used to determine statistically significant associations between these groups and their responses to survey questions. We used analysis of variance testing to compare means between groups. The McNemar test was used to determine whether there was a statistically significant difference between patients’ past experiences and future preferences for intervention by their primary care physician. Finally, we did stepwise logistic regression analyses to determine predictors of patients reporting any communication with their physicians about their weight, and to determine predictors of overweight and obese patients reporting previous help with weight loss from their physicians. Odds ratios and 95% confidence intervals were determined. We conducted all analyses using SAS software.²²