Document Type

Master's Culminating Experience

Publication Date



Purpose: The purpose of this project was to describe primary care physician adherence to National Heart Lung and Blood Institute (NHLBI) Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (1998) and to explore patient characteristics associated with physician assessment and management behaviors. Patient characteristics included age, sex, race, BMI, associated disease risk, and Medicaid coverage.

Methods: A chart abstraction of 99 randomly selected adult patients with at least one visit to a particular primary care practice during a 12-month period was completed. Patients were not pregnant during the year of review, and had a body mass index (BMI) of 25 kg/m2 or greater. The Physician Obesity Guideline Behavior Scale was developed to score physician obesity assessment and management behavior as recorded in the patient chart.

Results: Despite high screening rates, only 24% of clinically overweight or obese adult patients were actually diagnosed as such. All patients had a weight recorded in the chart, 84% had a height included, and 82% had a documented BMI. Weight-related management was minimal. The majority of patients did not receive any dietary (72%) or physical activity (69%) management. When dietary management was introduced, patients received either information (68%) or a goal (32%), and none received a goal with a plan. In cases where physical activity management was introduced, patients received information (39%) or a goal (52%), with few (10%) receiving a goal with accompanying plan. Physician assessment and management behaviors varied by patient BMI when controlled for race, insurance, and risk.