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posted: 6/10/2013 5:42 AM

Study: Fewer doctors counseling overweight patients

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By Jack Kelly
Pittsburgh Post-Gazette

Americans are fatter than ever, but fewer of their primary care physicians are warning them of the dangers of being overweight, a new study shows.

Researchers at the Penn State College of Medicine analyzed data from the National Ambulatory Medical Care Survey for the years 2007 and 2008 -- the most recent available data -- and for two years a decade earlier, 1995 and 1996.

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They found that while the percentage of Americans who are obese is now slightly greater than the percentage considered merely overweight, the number of primary care physicians counseling their patients about the importance of weight loss has declined.

The reasons for this are unclear, the Penn State researchers said. Jennifer Kraschnewski, assistant professor of medicine, suspects it's mostly because there are so many other demands competing for a doctor's time.

"Although (outpatient) visit duration actually has increased over the study time period, the number of items addressed during clinic visits has increased substantially more," she said. This suggests there is less time available for counseling.

The fact that doctors receive no reimbursement for counseling could be another factor, Kraschnewski said. Perhaps some doubt their overweight patients would heed their advice to shed some weight. And perhaps some don't offer lifestyle counseling because they haven't been trained well enough to do it, she said.

People who are obese make up 35.9 percent of all Americans, and 3.6 percent are morbidly obese, according to the U.S. Centers for Disease Control and Prevention. In 2008, the medical costs associated with obesity totaled $147 billion. On average, the medical bills of the obese were $1,429 higher than for those of normal weight.

Given the extent of the problem, there actually may be more weight loss counseling going on than the study indicates, said Esa Davis, an assistant professor of medicine at the University of Pittsburgh who conducts obesity research.

"There are primary care physicians who do a lot of (weight loss) counseling, but it's within the context of the disease being treated," Davis said.

Doctors who are treating overweight patients for diabetes, hypertension and other obesity-linked ailments will tell them they need to lose weight and why, she said. This would be clear from the physician's notes.

But researchers base their studies on how outpatient visits are coded, and these outpatient visits would be coded as treatment for diabetes or hypertension, not as weight loss counseling.

Davis dismissed concerns primary care physicians may not be getting enough training on lifestyle counseling in medical school.

"We're all trained to counsel," she said. "We do that every day."

And even if primary care physicians themselves are doing less lifestyle counseling, overweight and obese people may still be getting counseled because doctors and hospitals are moving toward a team-based approach for treatment of many ailments, Davis said.

"A patient may not be counseled on diet and exercise by the doctor but may be counseled by a nutritionist who is part of the team," she said.

Medical schools are placing more emphasis on the obesity epidemic and the importance of lifestyle changes, so one way or another overweight people are likely to be told what they need to hear, Davis said. Whether they'll heed the advice is a separate matter.

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