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What Do Physicians Recommend To Their Overweight and Obese Patients?

California Polytechnic State University (SP)
Brown Medical School and The Miriam Hospital, Providence, RI (FD, RRW)
Montefiore Hospital, Bronx, NY (MN)

Correspondence: Corresponding author: Suzanne Phelan, PhD, Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407 (E-mail: sphelan{at}capoly.edu)

Background: It is recognized that physicians play an important role in responding to the nation's obesity epidemic. Little is known, however, about what physicians say to their obese patients to help them lose weight.

Objective: This cross-sectional survey examined weight loss recommendations of family physicians and internists. Surveys were mailed to 188 physicians and 54% (n = 101) responded. The survey assessed physicians’ weight loss recommendations, the basis for recommendations, and their expected weight loss outcomes for a hypothetical patient. Physicians rated the extent to which they recommended various weight control strategies to their obese patients. They also rated the extent to which clinical experience, personal experience, and the medical literature were important in formulating their recommendations.

Results: The most common strategies recommended were increasing physical activity, reducing consumption of fast foods, reducing portion sizes, and reducing soda consumption. Physicians were less likely to recommended regular self-weighing, recording food intake, and decreasing television viewing. Meal replacements and weight loss medications were rarely advised. Physicians reported that they based their weight loss recommendations more on clinical experience than on the medical literature or personal experience; these latter 2 were rated as equally important. Physicians reported that, from their perspective, the equivalent of a 21.5% weight loss would be an "acceptable" outcome for a hypothetical obese patient; a 10.6% weight loss "disappointing."

Conclusions: Physicians, like patients, need to be educated about the benefits of modest weight loss and the weight loss strategies empirically proven to be most effective, including self-monitoring. Further research is needed to understand the barriers to recommending and implementing these effective strategies.

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