Primary Care Physicians Rarely Treat Obesity

Lara C. Pullen, PhD

January 13, 2015

Physicians seldom provide access to weight management interventions, according to primary care electronic health records in the United Kingdom. The lack of record may merely reflect poor recording of treatment. More likely, however, it points to poor patient access to body weight management interventions in the primary care setting.

Helen P. Booth, MSc, from Kings College London, United Kingdom, and colleagues report the results of their investigation in an article published online January 12 in BMJ Open. Theirs was a large, population-based sample of overweight and obese patients (n = 91,413) taken from different regions of the United Kingdom. The investigators analyzed primary care electronic health records from 2005 to 2012 for the treatment of overweight and obesity.

During the study period, 90% of overweight patients and 59% of morbidly obese patients had no recorded weight management intervention. The investigators found some evidence that clinicians prescribed antiobesity drugs more frequently to patients in the higher obesity category than patients in the overweight category. In addition, clinicians gave advice more commonly to patients in the overweight category than those in the obesity category.

Patients who did receive weight management intervention seldom had evidence of follow-up body weight measurements.

The results are consistent with studies from the United States that have revealed a decline in lifestyle advice and counseling for weight loss. The results also suggest that antiobesity drugs are more frequently prescribed now than they were 15 years ago.

The lack of treatment for overweight and obesity is not unique to the United Kingdom. Bartolome Burguera, MD, PhD, director of Obesity Programs at Cleveland Clinic in Ohio, who is not affiliated with the research but reviewed the article, commented on the findings to Medscape Medical News.

"[O]besity is still not considered a disease for many physicians in the US.... This situation occurs in spite of the recent recognition by the American Medical Association that obesity is a disease. The therapeutic approach to obesity has to overcome the widespread perception that obesity is self-inflicted and simply the result of eating too much and exercising too little," Dr Burguera said.

He explained that interventions should be specific and not a generic message to "eat less and move more." He emphasized the many different causes of weight gain, many of which can be identified in a detailed history. Weight gain may be, for example, a result of increased appetite, less activity as the result of an illness, recent pregnancy, childbirth, and so on.

Once the clinician has identified the underlying cause of weight gain, a therapeutic plan should include a personalized physical activity program, improvement of the diet, and a behavior modification plan. Patients may also benefit from medications to control appetite. All of this requires time, knowledge, and interest from the primary care physician.

Clinicians also need educate patients so that they understand that their weight status is likely contributing to their diabetes, hypertension, and/or osteoarthritis. Ideally, the education should encourage patients to take responsibility for this aspect of their health.

Unfortunately, some patients may lack motivation to lose weight because they have become frustrated from previous weight loss efforts. This is when weight loss drugs may be useful. Dr Burguera explained that physicians need to realize that weight loss drugs can be safe and effective.

The authors of the current study appear to agree with Dr Burguera's suggestions. They conclude their article by suggesting that medical records be used for structured recording of interventions for weight loss, as well as formal follow-up.

The authors have disclosed no relevant financial relationships. Dr Burguera consults for sanofi-aventis and Novo Nordisk.

BMJ Open. Published online January 12, 2015.

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