Primary Care Research

Primary care doctors consider several factors when deciding whether to counsel a patient about obesity

Primary care doctors know that their obese patients are placing themselves at risk for developing diabetes, high blood pressure, and a host of other medical problems, yet they often don't address their patient's weight problem. A complex set of factors influence doctors' decisions to provide preventive counseling for obesity, according to a new study. Several factors "set the stage" for the discussion. For example, most clinicians identified their belief that people who are not obese have a better quality of life as the most important factor in their decision to counsel. They are more inclined to address the topic of weight and exercise if they feel that the patient is motivated to change, has the personal resources to do so (for example, a safe neighborhood to walk in), and has fewer social and economic barriers to change.

Other factors emerge "as the door opens" into the examination room. For instance, clinicians judge a patient's body language and comments as indicative of receptivity to weight counseling, as well as their general knowledge of the patient. Doctors also look for a teachable moment. For example, when discussing the patient's diabetes or arthritis, they can mention that these conditions are worsened by obesity. The patient also may have other pressing matters that need to be addressed during the visit that compete with obesity counseling for time. Finally, the number of patients waiting to be seen, office staff present, and time of day also influence the delivery of weight counseling.

Thus, a wide range of competing demands affect both clinicians and patients, which may get in the way of obesity counseling, explains Robert L. Williams, M.D., M.P.H., of the University of New Mexico. Dr. Williams and colleagues, supported in part by the Agency for Healthcare Research and Quality (HS13496), surveyed 195 members of a Southwestern practice-based research network. They also examined the responses of 30 primary care network clinicians, who either were interviewed or participated in focus groups on the topic of preventive counseling for obesity.

More details are in "The art and complexity of primary care clinicians' preventive counseling decisions: Obesity as a case study," by Andrew L. Sussman, Ph.D., M.C.R.P., Dr. Williams, Robert Leverence, M.D., and others, in the July 2006 Annals of Family Medicine 4(4), pp. 327-333.

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