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.

Primary Care Residents' Knowledge, Attitudes, Self-Efficacy, and Perceived Professional Norms Regarding Obesity, Nutrition, and Physical Activity Counseling

“…[6][7][8][9][10][11] Although several guidelines exist for this counseling, 8,9,[12][13][14] and mounting evidence shows physician advice can encourage weight loss among patients, [15][16][17] weight-related counseling during ambulatory visits occurs at modest rates and is infrequently aligned with recommended methods shown to support behavior change. [18][19][20][21][22][23] Studies examining barriers to weight counseling in primary care practice suggest physicians feel inadequately trained, and report a lack of time and poor selfefficacy to counsel on weight management. [24][25][26][27][28] Additionally, physicians may hold negative attitudes toward overweight and obese patients and their ability to sustain change, which may inhibit counseling.…”

Development and Implementation of a New OSCE for Assessing Resident Competency in Weight Loss Counseling

“…Indeed, research demonstrates that didactic instructional style is negatively associated with attitudes and perceived professional norms toward counseling (Antognoli et al 2016) and the rate of obesity documentation and weight loss counseling appeared unchanged following a didactic presentation (Ren et al 2016). Program directors have called for additional opportunities for residents to practice and receive feedback on counseling skills (Antognoli et al 2014, Smith et al 2015. Furthermore, evidence suggests practicing weight loss counseling with SPs improves competency and confidence in counseling, and can clinically lead to patient weight loss , Jay et al 2013, Ockene et al 1999, Burton et al 2016).…”

“…As a result, many health organizations have published evidenced-based guidelines and recommendations for primary care physicians to screen patients for obesity and to provide weight loss counseling (Moyer& Force 2012, Jensen et al 2014, NIH 1998. However, despite these recommendations, weight loss counseling occurs infrequently during primary care visits (Antognoli et al 2014, Ma et al 2009, McAlpine & Wilson 2007. Furthermore, the rates of weight related counseling have declined in recent years (Kraschnewski et al 2013).…”

The Transition into Young Adulthood: a Critical Period for Weight Control

“…Even if emerging adults were to present in preventive care settings at rates comparable to other age groups, it is unlikely that they would receive effective weight management counseling given that that evidence-based counseling occurs at alarmingly low rates within the primary care setting. In fact, previous reports indicate that weight loss recommendations in accordance with NHLBI standards is low for the general patient population [71], and weight reduction advice occurs at less than 4% of primary care visits with emerging adults [69]. Interestingly, while emerging adults represented only 8% of patients enrolled in a multi-site primary care survey study, they were also the most willing to participate in a comprehensive weight loss program [72].…”