Addressing Obesity In Ambulatory Care: Is Physician Awareness The Problem ?

Abstract

LEARNING OUTCOME: to recognize the value of assessing current physician behavior for the development of a focused, practical nutrition education programDespite a recent national focus on health and fitness Americans are becoming fatter. Current studies estimate 30% of the adult population is overweight. Using height and weight data, a survey of our internal medicine resident's clinic revealed a 54% prevalence of obesity (n= 1160 patient visits). Although it is well recognized that excess body weight complicates the management of several medical conditions, housestaff appeared to pay little attention to obesity as a comorbid medical problem. This study was devised to define the frequency with which the housestaff addressed and documented the following factors: obesity as part of the history or physical exam, obesity as a distinct problem in the problem list or assessment, and intervention directed at obesity. We reviewed 1234 randomly selected patient records in an internal medicine resident's clinic. Obesity, defined as a body mass index (BMI) of >29.5 kg / m2, was identified in 55.6% of patients. The clinic notes of 559 obese (Ob)[mean BMI =37.0 kg/m2] and 106 normal to moderately overweight [mean BMI =27.2 kg/m2] patients were reviewed in detail. Obesity was documented in the history or physical exam of 29.7% of Ob patients, was listed as a distinct problem or in the assessment of 7.9% of these patients, and intervention for obesity was noted in 6.8% of Ob clinic notes. Hypertension (66% vs 47%) and diabetes (37% vs 27%) were noted more frequently in Ob vs. nonobese patients. Although the prevalence of obesity in our clinic is higher than that of general population, housestaff infrequently addressed obesity as a problem and intervention was rarely noted. Because moderate reductions in body weight can improve control of several medical conditions, teaching physicians to address obesity as a distinct problem could notably impact overall patient care. As a result of this study, an educational program is being developed to increase houseofficer awareness of obesity and to provide easy access for referral of patients to classes and counseling by a trained dietician