To meet the challenges of a growing obesity epidemic, primary care physicians (PCPs) need additional training and may need to refer patients to nutritionists or dietitians to help improve care, according to a national survey of 500 PCPs published online December 20 in BMJ Open. Implementing practice-based changes, such as having scales report body mass index (BMI), which could become a listed vital sign in a patient’s record, also may help improve care, the survey indicates.
Sara N. Bleich, PhD, assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues conducted a national cross-sectional online survey between February 9 and March 1, 2011, to get physicians’ perspectives on causes of obesity and whether PCPs felt that they were successful in treating obese patients.
“Overall, 75% of PCPs identified genetics or family history as an important cause of obesity, followed by metabolic effect (47%) and endocrine disorders (25%),” the researchers write. “Individual behavioural factors were the most commonly reported causes of obesity, with nearly all physicians citing insufficient physical activity (99%), overconsumption of food (99%), restaurant or fast-food eating (95%), consumption of [sugar-sweetened beverages] (94%) and lack of will power as important causes of obesity (89%).”
PCPs who completed medical school after 1991 were more likely than earlier graduates to cite restaurant/fast food eating (99% vs 90%; P < .01), lack of good eating habits information (80% vs 69%; P = .03), and poor access to health foods (64% vs 52%; P = .03) as causes of obesity.
Although almost all physicians reported that they felt competent in giving patients dietary counseling (90%) and exercise counseling (92%), fewer than half (44%) thought they achieved success by helping their obese patients lose weight. PCPs who graduated from medical school after 1991 were more likely to report success (49% vs 36%; P = .02).
“While PCPs who completed medical school more recently reported feeling more successful helping obese patients lose weight, these successful providers are still a minority,” the researchers write.
In addition, younger PCPs reported that nutritionists/dietitians were the most qualified provider to treat obese patients (48% vs 41%), then PCPs (41% vs 37%), and behavioral psychologists (9% vs 20%; P = .01). However, no single provider type garnered a majority of opinions as to who is the best to treat obesity patients.
Physicians overall reported that practice changes that could improve care, include adding BMI as a fifth vital sign (93%), including diet and exercise tips in patient records (89%), use of scales that report BMI (85%), and adding BMI to patient records (69%).
The authors acknowledge several weaknesses in their study design. “The key limitation of this study is that our measures of physician attitudes do not represent the full possible spectrum of attitude measures in the literature (such as perceived skills or comfort in caring for obese patients) which may bias our results towards the null,” they write. In addition, years since medical school completion serves only as a proxy for the type of education they may have received, and given the response rate, the results may not be generalizable.
“In order to begin improving obesity care, medical education should focus on enhancing those obesity-related skills PCPs feel most qualified to deliver as well as changing the composition of health care teams and practice resources,” the authors conclude.
“There are few differences in primary care physician perspectives about the causes of obesity or solutions to improve care, regardless of when they completed medical school, suggesting that obesity-related medical education has changed little over time,” Dr. Bleich said in a news release.
This research was supported by the National Heart, Lung, and Blood Institute and the Health Resources and Services Administration. The authors have disclosed no relevant financial relationships.