Discussing Weight with Obese Primary Care Patients: Physician and Patient Perceptions

Abstract

OBJECTIVE: To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN:Post-visit survey assessments of patients and providers. PARTICIPANTS:Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were recruited at the time of PC visits. MEASUREMENTS AND MAIN RESULTS:Percent patient-physician agreement and patient, provider and practice characteristics associated with agreement. Patients (456) and physicians (30) agreed about whether or not they discussed weight, physical activity (PA), and diet for 61% of office visits. There was disagreement on one of the items (weight, PA, or diet) for 23% of office visits, and for 2 or more of the items for 16% of the visits. Agreement was relatively greater for discussing weight than for discussing diet or physical activity. Physicians reported discussing weight issues more often than did patients. Overall patient-physician agreement was 0.51-0.59 (weighted Kappa statistic). In a multivariate analyses of factors associated with patient-physician agreement, health insurance (odds ratio [OR]=3.67, p value= 0.002), physician description of patient weight status (OR=2.27, p value=0.002), patient report of how weight relates to health (OR=1.70, p value=0.04), and female patient gender (OR=1.62, p=value=0.02) were significantly related to agreement. CONCLUSIONS:Patients and providers disagreed about whether or not weight issues were discussed in a large number of primary care encounters in this study. Physicians may be able to improve care for their obese patients by focusing discussions on specific details of diet and physical activity behaviors, and by clarifying that patients perceive weight-related information has been shared.

Prevalence and Determinants of Engagement with Obesity Care in the United States

“…Our finding that few individuals with obesity make it to the end of the cascade suggests that there is significant unmet need for obesity care at the population level. Engaging with this last step is essential to gaining access to managed, effective care and can result in a myriad of treatment outcomes, including behavioral modification, pharmacotherapy, bariatric surgery, and/or referral to another care provider 17, 18, 19, 20, 21. Our findings thus highlight the need for physicians to engage in conversation about obesity treatment at routine clinical visits, even when patients are not seeking obesity care.…”

Facilitating Factors and Barriers to Weight Management in Women: Physician Perspectives

“…For example, in a study examining the degree of agreement in which weight was discussed between patients who were obese and providers, Greiner and colleagues observed that, compared to patients, providers were more likely to report discussing weight management. 35 This discrepancy highlights the importance of effective patient-provider communication and how patients and providers perceive their own and each other's communication.…”

“…[38][39][40][41] Conversely, physicians who were perceived as disrespectful and insincere were perceived by patients as being less motivating, ineffective in encouraging behavior change, and left patients feeling hopeless. 35,37 This underscores the need for implementing the clinical strategy of "motivational interviewing" to address the Institute of Medicine's aim for improving the health care delivery system through patient-centered approaches. 42 It can be inferred that physicians in the current study had similar interactions with patients.…”

Fet, feit eller bare overvektig?

“…I en studie fant man at pasientene langt sjeldnere enn legene mente at vekten ble omtalt. Mest avvikende oppfatning hadde pasienter som i liten grad hadde forsøkt å gå ned i vekt på egen hånd (22), hvilket understreker kompleksiteten ved å samtale om dette.…”