Documentation and Treatment of Obesity in Primary Care Physician Office Visits in Results from the National Ambulatory Medical Care Survey: The Role of the Patient-Physician Relationship

Corresponding Author: Arch G. Mainous III, PhD; University of Florida - Department of Health Services Research, Management and Policy.

Email: arch.mainous@ufl.edu

DOI: 10.3122/jabfm.2022.220297R1

Keywords: Chronic Disease, Health Care Surveys, National Ambulatory Medical Care Survey, Obesity, Primary Care Physicians, Primary Health Care

Dates: Submitted: 08-31-2022; Revised: 11-08-2022; Accepted: 11-14-2022

Status: In production for ahead of print. 

INTRODUCTION: Obesity is a major cause of morbidity and mortality any many adults in the US are obese. An ongoing patient-physician relationship may increase the likelihood of acknowledging obesity and providing a treatment plan to patients with obesity. The purpose of the study was to investigate if continuity of care was associated with recording of obesity and receipt of a weight loss treatment plan.

METHODS: We analyzed data from the 2016 and 2018 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits which we limited to primary care. Only adult patients with a measured body mass index in the visit of > 30 were included (unweighted sample of n=1,623; US population estimate of 101,432,875 visits). Our primary measures were acknowledgement (diagnosis or checklist) of obesity, treatment of obesity, continuity of care and obesity associated comorbid conditions.

RESULTS: Among patients who were objectively obese, only 30.6% had an acknowledgement of the patient's body composition in the visit. In total, 26.9% were receiving some weight management treatment plan whether or not the obesity was recorded. In adjusted analyses, continuity of care was not significantly related to recording of obesity (OR 0.90; 95% CI 0.51-1.58) but continuity of care did significantly increase the likelihood of treatment for obesity (OR 2.08; 95% CI 1.23-3.51). Continuity of care was only significantly related to obesity treatment when defined as a visit with the patient’s established primary care physician. The effect was not seen with continuity with the practice.

DISCUSSION: There are many missed opportunities for prevention of obesity related disease. Continuity of care with a primary care physician was associated with benefits in treatment likelihood but greater emphasis on managing obesity in a primary care visit seems warranted.

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