Most primary care physicians aren’t up to par when it comes to discussing diet, exercise or weight control with their overweight patients, according to a new study.
The study showed that 60 percent of primary care physicians surveyed said they don’t always provide their overweight adult patients with counseling on diet, physical activity and weight control .
And 51 percent of the 1,200 primary care physicians surveyed said they don’t regularly assess their adult patients’ BMIs, although guidelines from the National Institutes of Health urge them to do so.
Doctors treating overweight children were more likely to talk about these issues with their patients than doctors treating adults, the study showed.
The results showed that not enough doctors are engaging in behavior interventions with their patients, said study researcher Ashley Wilder Smith, a behavioral scientist at the National Cancer Institute.
“We need to provide tools to physicians, to help primary care be a front line” in solving the obesity epidemic, Smith said. The results will be published in the July issue of the American Journal of Preventative Medicine.
A focus on physical activity
Among the doctors surveyed, all were more likely to counsel their patients on physical activity than on diet or weight control, Smith said.
“I think that the messages related to physical activity are easier to understand,” Smith explained. “We tell people the number of minutes per week that they should be exercising, whereas diet is much more complex , and weight control has a certain stigma.”
When asked about their discussions with their adult patients, 86 percent of family practice physicians said they always or often discuss physical activity with their overweight patients, 83 percent said they discuss diet and nutrition, while 56 percent said they discuss weight control, the study showed.
This can be a problem because patients who are severely overweight often need to lose weight before they can really begin to exercise safely, said Dr. Thomas McKnight, who treats families at Hurlburt Air Force Base in Florida.
It’s easy for patients to take in more calories by eating than they are burning with exercise, McKnight said. “The elbow is more powerful than the knees, in that sense,” McKnight said.
It’s important for family doctors to address weight issues because doctors who see their patients over long periods of time are best equipped to take into account a patient’s life situation and determine the best timing for a weight loss intervention, McKnight told MyHealthNewsDaily.
“A dietician doesn’t know someone is depressed or going through a divorce ,” he said.
The road to improvements
Changes in health care will make it easier for doctors to intervene in their patients’ weight issues, and will make these interventions more effective, McKnight said.
“Over the coming years, this will be studied,” and more doctors will take on the challenge of dealing with these issues, he said.
McKnight said that doctors need training programs to help them learn the best approaches to counseling such patients. When doctors are given a better understanding of how long it takes for patients make behavioral changes , they will put more time and effort into counseling, he said.
For example, doctors must learn that it can take several appointments before overweight patients will start to heed advice about their behaviors, McKnight said.
“It’s a frustration for most doctors, they haven’t been trained in how behavior changes, and there’s no evidence-based model about how to give patients step-by-step counseling” on weight issues, he said.
Another hurdle physicians have faced is that they have not paid to provide such counseling. The new health care law changes this, he said. It allows physicians to be paid for monthly appointments with obese patients to provide such counseling, and the law provides that patients do not have to pay co-pays for these visits.
The increasing use of electronic medical records will also help, McKnight said. In such records, a patient’s BMI is automatically calculated, so doctors will be unable to ignore the numbers that are right in front of them.
Pass it on: More doctors need to counsel their patients on weight problems.
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