Translational research - Implementation of NHLBI obesity guidelines in a primary care community setting: The physician obesity awareness project

Background: Greater than 65 percent of the United States (US) population is overweight, with 32 percent obese. It is a problem in both developed and developing nations. While guidelines exist, counseling by physicians about obesity and weight loss is inconsistent, and physician approaches to obesity management have limited success. This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity. Twenty-one physicians in a suburban, middle class population in the Midwestern United States participated. Methods: Physician obesity awareness, weight, height, BMI, blood pressure, lipids, and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up. All 21 physicians received academic detailing and were presented with their clinical outcomes. Ten physicians received an Enhanced Intervention. They were additionally asked to place a sticker in the chart of their overweight or obese patients. Results: Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline, decreasing to 0% at follow-up (p = 0.041). Reference to obesity management by Intervention physicians increased from 2.4% to 9.2% (p =0.001) while for Enhanced Intervention physicians documentation increased from 3.9% to 15.6% (p = 0.002). Those patients in the Enhanced Intervention group lost an average of 6.19 lbs (3.3%) (p = 0.083) during the one year period versus 4.6 lbs (2.5%) (p = 0.20) in the Intervention group. The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group. The data from both groups was pooled at both baseline and follow-up. The average weight of patients decreased from 185.7 lbs to 180.3 lbs (excluding outliers weighing > 311 lbs). This 5.4 pound loss was significant (p = 0.027). The BMI decreased from 30.1 to 29.1 (p = 0.095). Cardiovascular co-morbidities improved. Conclusion: Obesity and overweight have a very high prevalence in a primary care community based settings. Clinicians are not comfortable diagnosing and managing obese and overweight patients. A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss.