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Research ArticleOriginal Research

Documentation and Treatment of Obesity in Primary Care Physician Office Visits: The Role of the Patient-Physician Relationship

Arch G. Mainous, Zhigang Xie, Samuel B. Dickmann, James F. Medley and Young-Rock Hong
The Journal of the American Board of Family Medicine April 2023, 36 (2) 325-332; DOI: https://doi.org/10.3122/jabfm.2022.220297R1
Arch G. Mainous III
From the Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM, SBD, JFM); Department of Health Services Research, Management, and Policy, University of Florida, Gainesville (AGM, YRH); Department of Public Health, University of North Florida, Jacksonville (ZX).
PhD
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Zhigang Xie
From the Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM, SBD, JFM); Department of Health Services Research, Management, and Policy, University of Florida, Gainesville (AGM, YRH); Department of Public Health, University of North Florida, Jacksonville (ZX).
PhD
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Samuel B. Dickmann
From the Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM, SBD, JFM); Department of Health Services Research, Management, and Policy, University of Florida, Gainesville (AGM, YRH); Department of Public Health, University of North Florida, Jacksonville (ZX).
MD
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James F. Medley
From the Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM, SBD, JFM); Department of Health Services Research, Management, and Policy, University of Florida, Gainesville (AGM, YRH); Department of Public Health, University of North Florida, Jacksonville (ZX).
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Young-Rock Hong
From the Department of Community Health and Family Medicine, University of Florida, Gainesville (AGM, SBD, JFM); Department of Health Services Research, Management, and Policy, University of Florida, Gainesville (AGM, YRH); Department of Public Health, University of North Florida, Jacksonville (ZX).
PhD, MPH
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Article Figures & Data

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    Figure 1.

    Weighted prevalence of recorded obesity and obesity treatment by continuity of care in primary care visits.

Tables

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    Table 1.

    Sample Characteristics of Primary Care Visits by Continuity of Care (n = 1,623, Weighted n = 101,432,875)

    Continuity of Care
    CharacteristicsnWeighted nNo
    n = 399
    Weighted n = 20,916,945
    (25.8%)
    Yes
    n = 1,224
    Weighted n = 80,515,930
    (84.6%)
    Adjusted Odds of Continuity of CareP Value
    Age group
    18 to 44 years44926,383,82937.9 (30.6 to 45.1)22.9 (19.2 to 26.7)Reference
    45 to 64 years72546,451,32237.6 (32.5 to 42.6)47.9 (44.2 to 51.7)1.3 (0.92 to 1.83)0.135
    ≥65 years44928,597,72424.5 (17.2 to 31.9)29.1 (25.2 to 33.1)0.6 (0.35 to 1.02)0.057
    Race/ethnicity
    Non-HispanicWhite113169,710,55664.7 (55.1 to 74.2)69.8 (63.6 to 76.0)Reference
    Non-Hispanic Black20912,043,48013.6 (8.1 to 19.1)11.4 (8.5 to 14.4)0.71 (0.4 to 1.25)0.235
    Hispanic23115,747,40615.6 (9.1 to 22.2)15.5 (9.8 to 21.2)1.22 (0.62 to 2.41)0.567
    Other523,931,4336.2 (2.5 to 9.8)3.3 (1.5 to 5.1)0.57 (0.19 to 1.69)0.307
    Sex
    Female99160,512,27072.6 (66.3 to 78.9)56.3 (52.1 to 60.5)Reference
    Male63240,920,60627.4 (21.1 to 33.7)43.7 (39.5 to 47.9)1.97 (1.33 to 2.91)0.001
    Payment type
    Private88955,933,77155.8 (42.8 to 68.8)55.0 (50.1 to 59.9)Reference
    Public57734,364,74118.2 (12.2 to 24.2)38.0 (33.5 to 42.4)2.46 (1.56 to 3.87)<0.001
    Other15711,134,36326.0 (10.1 to 41.9)7.1 (3.7 to 10.4)0.27 (0.11 to 0.66)0.004
    Body mass index
    30-<3584852,357,96754.2 (46.3 to 62.1)50.9 (47.1 to 54.8)Reference
    35-<4044128,484,77427.0 (21.6 to 32.4)28.4 (25.4 to 31.3)1.09 (0.73 to 1.64)0.678
    ≥4033420,590,13418.8 (12.4 to 25.1)20.7 (17.7 to 23.7)1.14 (0.69 to 1.89)0.605
    # Chronic conditions
    054932,225,63551.4 (42.8 to 60.0)26.7 (22.6 to 30.7)Reference
    136023,781,40321.3 (15.1 to 27.5)24.0 (20.4 to 27.7)2.38 (1.5 to 3.78)<0.001
    ≥271445,425,83727.3 (20.3 to 34.3)49.3 (44.0 to 54.6)3.13 (2.03 to 4.81)<0.001
    • View popup
    Table 2.

    Association of Continuity of Care with Recorded Obesity and Obesity Treatment in Primary Care Visits

    Recorded ObesityReceiving Obesity Treatment
    aOR (95% CI)P ValueaOR (95% CI)P Value
    Continuity of care
    No1.001.00
    Yes0.90 (0.51-1.58)0.7192.08 (1.23-3.51)0.007
    Age group
    18 to 44 years1.001.00
    45 to 64 years0.76 (0.50-1.15)0.1880.87 (0.63-1.19)0.378
    ≥65 years0.80 (0.47-1.38)0.4230.76 (0.45-1.29)0.303
    Race/ethnicity
    Non-Hispanic White1.001.00
    Non-Hispanic Black0.91 (0.55-1.52)0.7161.29 (0.80-2.09)0.292
    Hispanic1.42 (0.67-3.02)0.3652.44 (1.25-4.76)0.009
    Other0.35 (0.12-1.02)0.0541.10 (0.50-2.41)0.810
    Sex
    Female1.001.00
    Male0.83 (0.61-1.12)0.2111.03 (0.80-1.34)0.799
    Payment type
    Private1.001.00
    Public0.80 (0.53-1.19)0.2690.96 (0.61-1.51)0.849
    Other1.05 (0.48-2.26)0.9101.23 (0.64-2.35)0.533
    Body mass index
    30 < 351.001.00
    35 < 402.04 (1.34-3.13)0.0011.02 (0.72-1.44)0.910
    ≥405.42 (3.58-8.22)<0.0011.72 (1.19-2.49)0.004
    # Chronic conditions
    01.001.00
    11.27 (0.81-2.00)0.2981.75 (1.10-2.80)0.019
    ≥22.45 (1.54-3.91)<0.0011.77 (1.14-2.74)0.012
    • Multivariable logistic regression models were adjusted for age, race and ethnicity, sex, payer type, body mass index, and the number of comorbidities.

    • Abbrevaiations: aOR, adjusted odds ratios; CI, confidence interval.

    • View popup
    Table 3.

    Subgroup Analysis: Association of Frequency of Visit with Recorded Obesity and Obesity Treatment Among Patients with Continuity of Care

    Recorded ObesityReceiving Obesity Treatment
    aOR (95% CI)P ValueaOR (95% CI)P Value
    Model 1—linear term
    # Visits in the past 12 months1.04 (1.01-1.07)0.0180.98 (0.94-1.02)0.346
    Model 2—quartile level
    Q1: ≤21.001.00
    Q2: 3 to 41.04 (0.68-1.59)0.8460.83 (0.55-1.26)0.380
    Q3: 5 to 61.03 (0.65-1.62)0.9160.85 (0.50-1.45)0.544
    Q4: >61.86 (1.14-3.04)0.0130.75 (0.45-1.26)0.271
    • Multivariable logistic regression models were adjusted for age, race and ethnicity, sex, payer type, body mass index, and the number of comorbidities.

    • Abbrevaiations: aOR, adjusted odds ratios; CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 36 (2)
The Journal of the American Board of Family Medicine
Vol. 36, Issue 2
March/April 2023
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Documentation and Treatment of Obesity in Primary Care Physician Office Visits: The Role of the Patient-Physician Relationship
Arch G. Mainous, Zhigang Xie, Samuel B. Dickmann, James F. Medley, Young-Rock Hong
The Journal of the American Board of Family Medicine Apr 2023, 36 (2) 325-332; DOI: 10.3122/jabfm.2022.220297R1

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Documentation and Treatment of Obesity in Primary Care Physician Office Visits: The Role of the Patient-Physician Relationship
Arch G. Mainous, Zhigang Xie, Samuel B. Dickmann, James F. Medley, Young-Rock Hong
The Journal of the American Board of Family Medicine Apr 2023, 36 (2) 325-332; DOI: 10.3122/jabfm.2022.220297R1
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