Physician Counseling May Help Overweight, Obese Patients Confront Weight Issues

Laurie Barclay, MD

March 01, 2011

March 1, 2011 — Physician counseling may help overweight or obese patients confront weight issues, according to an analysis of data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) reported in the February 28 issue of the Archives of Internal Medicine.

"Physician counseling is effective in promoting healthy behavior," write Robert E. Post, MD, MS, from the Medical University of South Carolina, Charleston, and colleagues. "We evaluated whether patient reports of physician acknowledgment of overweight patients' weight status are associated with the patients' perceptions of their own weight and desire to lose weight."

Using NHANES data on adults aged 20 to 64 years with body mass index (BMI) of at least 25.0 (calculated as weight in kilograms divided by height in meters squared), the investigators carried out logistic regressions to assess the effect of reports of physician acknowledgment of patients' weight status on patients' perceptions of their weight, desire to weigh less, and attempts to lose weight.

Participants with a BMI of 25 kg/m2 or above and those with a BMI of 30 kg/m2 or above were more likely to perceive themselves as overweight if they were told by their physician that they were overweight, according to results of logistic regressions controlling for relevant confounding variables. Odds ratios (ORs) were 6.11 (95% confidence interval [CI], 4.38 - 8.53) and 7.58 (95% CI, 5.83 - 9.84), respectively.

Furthermore, participants who reported being told they were overweight were more likely to have attempted to lose weight in the previous 12 months, with ORs of 2.51 (95% CI, 2.15 - 2.94) for participants with a BMI of 25 kg/m2 or more and 2.24 (95% CI, 1.74 - 2.88) for those with a BMI of 30 kg/m2 or more. However, only 45.2% of participants with a BMI of 25 kg/m2 or more and 66.4% of those with a BMI of 30 kg/m2 or more reported being told by a physician that they were overweight.

"Among patients who were overweight or obese, patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients' own weight, desire to lose weight, and recent attempts to lose weight," the study authors write.

Limitations of this study include cross-sectional design, precluding determination of causality; inability to determine the extent of the physician intervention; misclassification of overweight based on BMI in very muscular people; and inability to identify the type of visit in which the patients were encountering the physician.

"Physicians need to tell more overweight and obese patients that they are overweight because this may help encourage them to change their behavior to lose weight and lower their risk for many diseases," the study authors write. "This is an important intervention point that is being missed by many physicians."

In an accompanying invited commentary, Robert B. Baron, MD, MS, from the University of California, San Francisco, recommends treating BMI as a routine vital sign that should be calculated at each visit.

"Office-based approaches to obesity management remain extremely challenging," Dr. Baron writes. "Early recognition of overweight and obesity and communication to patients about the realities of their weight is an important initial step to successful behavior change. Implementing or referring patients for intensive weight loss interventions may be effective for some patients, and successful weight maintenance can be achieved by a subpopulation of those who successfully lose weight."

The study authors and Dr. Baron have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:316-321, 321-322. Abstract Extract

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