Evidence-based guidelines recommend screening all patients for weight problems and classifying or diagnosing them as overweight or obese (M. D. Jensen et al., 2013). Recording of height and weight and waist circumference and calculating BMI are important steps in this classification. Making a separate, official diagnosis of obesity is associated with greater likelihood of a weight-management plan being developed (Mattar et al., 2017).
Despite the evidence to support these recommendations, weight and height data needed to assess for obesity using BMI is lacking in roughly 50% of medical records (STOP Obesity Alliance, 2010). Primary care physicians and other primary care clinicians do not consistently assess, diagnose, counsel, or advise patients who are overweight or obese (Mattar et al., 2017; Muo, Sacajiu, Kunins, & Deluca, 2013; Smith et al., 2011).
Additionally, physicians frequently report a lack of training and competence in weight management (Dietz et al., 2015; Sabin, Marini, & Nosek, 2012; STOP Obesity Alliance, 2010). In our survey of primary care providers, (N= 25) 84% felt they needed training in interpreting waist circumference, while 64% said they “rarely or never” assessed patients for overweight or obesity using waist circumference. Another 72% of providers felt they needed training in identifying risk factors for comorbid conditions (Tanner, 2011).
Practice Gap References
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Dietz, W., Baur, L., Hall, K., Puhl, R., Taveras, E., Uauy, R., & Kopelman, P. (2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet. http://dx.doi.org/10.1016/S0140-6736(14)61748-7
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Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
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Mattar, A., Carlston, D., Sariol, G., Yu, T., Almustafa, A., Melton, G. B., & Ahmed, A. (2017). The prevalence of obesity documentation in Primary Care Electronic Medical Records. Applied Clinical Informatics, 8(1), 67–79. https://doi.org/10.4338/ACI-2016-07-RA-0115
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Muo, I. M., Sacajiu, G., Kunins, H., & Deluca, J. (2013). Effect of the availability of weight and height data on the frequency of primary care physicians documented BMI, diagnoses and management of overweight and obesity. Quality in Primary Care, 21(4). Retrieved from http://primarycare.imedpub.com/abstract/effect-of-the-availability-of-weight-andrnheight-data-on-the-frequency-of-primaryrncare-physicians-documented-bmirndiagnoses-and-management-of-overweightrnand-obesity-111.html
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Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLOS ONE, 7(11), e48448. https://doi.org/10.1371/journal.pone.0048448
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Smith, A. W., Borowski, L. A., Liu, B., Galuska, D. A., Signore, C., Klabunde, C., … Ballard-Barbash, R. (2011). U.S. primary care physicians’ diet-, physical activity-, and weight-related care of adult patients. American Journal of Preventive Medicine, 41(1), 33–42. https://doi.org/10.1016/j.amepre.2011.03.017
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STOP Obesity Alliance. (2010). Provider/Patient Survey on Obesity in the Primary Care Setting. STOP Obesity Alliance. Retrieved from http://www.stopobesityalliance.org/research-and-policy/research-center/survey-results/
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Tanner, B. (2011). Improving Obesity Outcomes Through Interactive Web-Based Clinical Skills Training | SBIR.gov. Retrieved April 3, 2019, from https://www.sbir.gov/sbirsearch/detail/389149
