Docs Often Skip Counseling Arthritis Patients on Weight Loss

Nicola Parry, DVM

May 04, 2018

Although weight-loss counseling has increased, more than half of adults with arthritis and overweight or obesity do not receive it from their clinician, a study published in the May 4 issue of the Morbidity and Mortality Weekly Report suggests.

"From 2002 to 2014, the percentage of adults with arthritis and overweight or obesity who reported receiving provider weight-loss counseling increased by 10.4 percentage points," write Dana Guglielmo, MPH, from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues.

"These improvements are encouraging; however, approximately 75% of adults with overweight and 50% of those with class 1 obesity are not receiving provider weight-loss counseling."

In the United States, more than 54 million adults have arthritis. One third or more of these individuals also have overweight or obesity, and the American College of Rheumatology recommends weight loss among this patient population to help manage their osteoarthritis symptoms.

Indeed, according to Guglielmo and colleagues, adults with overweight or obesity who receive weight loss counseling from their clinician are approximately four times more likely to attempt weight loss than are patients who do not receive counseling. And one of the aims of the Healthy People 2020 initiative is to improve clinician weight loss counseling among patients with arthritis with overweight or obesity.

With this in mind, the researchers examined changes in clinician counseling for weight loss among this patient population, using data from the National Health Interview Survey from 2002 to 2014. They included responses from adults aged 18 years and older with arthritis who have overweight or obesity.

Overall, 28.3 million adults in 2002 and 38.9 million in 2014 had both arthritis and overweight or obesity.

The prevalence of clinician counseling for weight loss among these individuals increased by 10.4% during the study period, rising from 35.1% (95% confidence interval [CI], 33.0% - 37.3%) in 2002 to 45.5% (95% CI, 42.9% - 48.1%) in 2014 (P < .001).

"By obesity subgroup, the prevalence increased 11.8 percentage points among persons with class 1 obesity (40.8% to 52.6%; p<0.001) and 15.5 percentage points among those with class 3 obesity (69.0% to 84.5%; p<0.001)," the authors write.

In contrast, the increase in weight loss counseling prevalence among individuals with class 2 obesity was not significant, remaining between 60% and 70% throughout the study.

However, despite the overall rise in counseling, the authors stress that approximately 75% of adults with arthritis and overweight, and 50% of those with class 1 obesity, are still not receiving weight loss counseling from their clinicians.

Guglielmo and colleagues suggest that including clinical decision supports in electronic medical records could help improve counseling rates. Increased training for clinicians around supporting patient self-management of weight loss might also help.

The authors also acknowledge some limitations of their study. In particular, they stress that the National Health Interview Survey data are self-reported, and some features might be susceptible to recall or social desirability bias, the latter of which could lead to underestimation of body mass index. Survey response rates were also low, they add, which could also bias results.

Nevertheless, they applaud the increase in clinician counseling for weight loss among adults with arthritis and overweight or obesity from 2002 to 2014, and stress that continued progress in this area can help ensure that as many of these patients as possible receive appropriate guidance and support for weight loss.

"Through combined counseling for weight loss, physical activity, and self-management education, and by making referrals to evidence-based programs, providers can help their patients with arthritis make meaningful improvements in quality-of-life and long-term health outcomes," the authors conclude.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2018;67:485-490. Full text

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