Family practice residents' identification and management of obesity
This study, involving 25 family practice residents and 2746 patients in a family practice residency programme, addressed four hypotheses regarding the identification and management of obesity in the primary care setting: (i) the physician-identified prevalence of obesity is significantly lower than the actual prevalence in the population, (ii) obesity is more likely to be addressed with management actions when it is recorded on the medical record problem list than when it is not recorded, (iii) physician actions dealing with obesity are influenced by the patient's age, sex, level of motivation, and body mass index (BMI) value, and (iv) the type of physician management actions taken are affected by the patient's age, sex, level of motivation, and level of BMI value. Obesity was identified as a risk factor by physicians for 51.6% of all patients with a BMI greater than or equal to 30. Obesity was recorded on the medical record problem list for 70.6% of the physician-identified obese patients. When obesity was recorded on the problem list, management actions were taken for 92.9% of patients. However, when obesity was recorded on a risk factor evaluation form but not on the problem list, management actions were taken for only 56.6% of patients. Self-care strategies were selected as the management strategy more frequently than return visits. Demographic characteristics, BMI value and level of patient motivation did not influence the selection of follow-up management strategies. Given the potential for significant improvement in a patient's health status through early recognition and aggressive management of obesity, the barriers to physician identification and involvement in clinical management of obesity deserve further investigation.