Survey reveals differences in weight-related counseling among medical specialties

Fewer than half of primary care physicians for adults talk to their patients about diet, exercise and weight management consistently, while pediatricians are somewhat more likely to do so, according to two new studies.

These findings come from two National Cancer Institute surveys of family physicians, internists, obstetrician/gynecologists and pediatricians. Participants reported how often they advised patients on diet, exercise and weight control; how often they tracked patient weight or assessed their body mass index (BMI); and how often they referred patients for further management of their weight.

The differences in weight-related counseling among medical specialties stood out, said Ashley Wilder Smith, Ph.D., program director in the Applied Research Program at the National Cancer Institute, and lead author of the studies."Obstetrician/ gynecologists were much less likely to be participating in a number of areas of counseling. That was a surprise, especially considering the focus on overweight and pregnancy."

Both studies appear online and in the July issue of the American Journal of Preventive Medicine. One study evaluated the responses of physicians who treat adults and the other those who treat children.

In the pediatric study, about 61 percent of all primary care physicians treating children, either family physicians or pediatricians, regularly assessed obesity using the BMI percentiles of their patients, although almost all measured height and weight regularly.

However, Smith said, pediatricians were more likely than family physicians to assess BMI ─ 74 percent compared with 53 percent ─ and to provide behavioral counseling to patients and their parents.

Tracking BMI is one of the National Institutes of Health guidelines for all physicians.

In treating children, pediatricians were much more likely to consult on all areas of weight control than family physicians, Smith said. "But family physicians held together as a specialty on the separate surveys. Those treating adults had strikingly similar findings to those treating children."

"We found that physicians were more likely to counsel on physical activity than on diet or weight control, and more likely to counsel on diet than on weight control," Smith said. "Though I was surprised that physicians discussed physical activity the most, in retrospect, I think diet is a more complicated behavior. The messages are a bit more difficult to deliver."

Part of the problem could be the limited time that physicians have with patients during the usual office visit and the attitude that this is not enough time to address weight issues.

"But it is doable," said Thomas McKnight, M.D. "Most people do not believe it is." McKnight is a family physician with the U.S. Air Force at Hurlburt Field, in Florida.

McKnight said that patients need to hear the message that they can lose weight several times before they might be ready to act on it. He hands out a brochure about weight management to his patients with weight issues. "Four out of five times that brochure goes in the trash. But then when they are ready, they come for a weight management appointment."

The situation has improved since the surveys took place in 2008, said Sandra Hassink, M.D., chairperson of the Obesity Leadership Work Group of the American Academy of Pediatrics. Weight management recommendations have escalated in pediatrics even since then, she said. A recent poster at an AAP meeting reported that 88 percent of pediatricians are calculating BMI for their patients, she said. "This is still a work in progress and we are escalating the push to have all pediatricians do this."

The AAP has created tools for pediatricians, such as flip charts, to help incorporate diet, exercise and weight management into their practices for patients at all age levels, Hassink said. The message must be given to the whole family, she added. "Many parents are taking the message in for themselves as well."