Weight Management: What Patients Want from Their Primary Care Physicians

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Original Research

Weight Management: What Patients Want from Their Primary Care Physicians

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

References

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Results

Patient Characteristics

The demographic characteristics of the patients are presented in Table 1. We found that 160 patients (44%) were not overweight, 101 (28%) were overweight, and 106 (29%) were obese. The patients in each group were similar in the number of visits to and the length of time with their primary care physicians. Obese patients were more likely to be African American or Latino and were less likely to be Asian American than patients who were not obese (P <.001). The prevalence of obesity-related comorbidities increased with higher BMI (P <.001). Ninety-seven percent of obese patients, 84% of overweight patients, and 39% of non-overweight patients felt they needed to lose weight (P <.001).

Prevalence of Physician-Patient Communication About Weight

We asked all patients if they had discussed their weight with their physicians in the past Table 2. Patients with higher BMIs were more likely to have had such a discussion. Those with lower BMIs were more likely to indicate that they had not needed help from their physicians with their weight in the past, and they were also more likely to indicate that they did not want such help in the future (P <.001 for all associations). Nearly all patients said they would be comfortable discussing weight with their physicians.

Attitudes of Patients Who Think They Need to Lose Weight

Table 3 shows the attitudes of patients who said they needed to lose weight. Most patients in all 3 categories indicated that weight loss was important to them and that their weight affected their happiness. However, patients with a higher BMI were more likely to state that their weight affects their health. Most patients in each group chose exercise and diet as the best methods of weight loss. However, patients with higher BMIs were more likely to want to be referred to a weight loss program. These patients were also more likely both to have felt that their physicians had helped in the past and that they could help in the future, and these patients had more ambitious weight loss goals (P <.001 for all associations).

What Was Done in the Past and What Patients Want in the Future

We asked all patients (regardless of whether they said they needed to lose weight) what their physicians had done about their weight in the past and what they would like from their physicians in the future Table 4. The most common experience reported was that physicians had not brought up weight. The patients reported a variety of other interventions that occurred, but none with a frequency greater than 20%. However, obese patients reported that their physicians intervened more. Although 33% of obese patients reported that their physicians had not brought up their weight, 48% of those patients said that they had been told to lose weight. The most common additional interventions reported by obese patients were: (1) a discussion of the health risks of obesity (31%), (2) exercise recommendations (30%), and (3) dietary advice (27%).

The most commonly cited future preferences for physician assistance of all patients were: (1) dietary advice (28%), (2) help setting realistic weight goals (27%), and (3) exercise recommendations (26%). The least-desired specific interventions were for their physicians to not bring up weight (12%) and for the physicians to say they do not have a weight problems (3%). Patients in all groups wanted substantially more future involvement by their physicians than they had experienced in the past, especially in setting realistic weight goals. Patients with higher BMIs were more likely to report both a higher level of intervention in the past and a desire for a higher level of intervention in the future. For example, although 13% of the obese patients stated that their physicians had helped them set realistic weight goals in the past, 46% said they would like their physicians to help them set realistic weight goals in the future, a difference of 33% (P <.001).

Predictors of Physician-Patient Communication About Weight

We did stepwise logistic regression analyses to determine predictors of physician-patient communication about weight. The logistic regression models offered the variables of Table 1 and patient BMI as candidates for consideration of statistical significance. For patients with BMIs less than 25 (not overweight), we found no significant predictors of such communication. For patients with BMIs greater than 25 (overweight or obese), we found that the diagnoses of diabetes (odds ratio [OR] =3.2; 95% confidence interval [CI], 1.2-9.2), high cholesterol (OR=2.6; 95% CI, 1.1-6.0), and depression (OR=2.4; 95% CI, 1.0-5.7) were predictive of patients reporting such a discussion had occurred in the past. Also, higher BMIs were also predictive of physician-patient communication about weight (OR=1.2; 95% CI, 1.1-1.3).