Most Clinicians Currently Do Not Address Obesity

Despite the weight of the evidence and the broad consensus, there remains a great deal of clinical inertia against making a diagnosis of obesity and advising patients to lose weight. One study of more than 55,000 ambulatory care visits from the mid-1990s found that physicians reported obesity in only 38% and counseled only one-quarter of their obese patients (27). In another study of more than 12,000 obese adults, only 42% were advised to lose weight, and yet those who were so advised were more likely to try to do so (28). One might think that things have improved over the past 10 yr, but a recent study found that the number of patients who received advice to lose weight was actually lower in 2000 than it was in 1994 (40%, down from 44%) (29). Physicians feel that there are many barriers to counseling their patients about weight loss. These include insufficient confidence, knowledge, and skills, as well as a perception that there are no effective therapies (30). Physicians seem more likely to discuss weight management with their patients who have comorbid illnesses or are severely obese, or with those who are more educated and have a higher socioeconomic status (29,31). This is despite the fact that helping patients change their lifestyle behaviors, use weight loss medications, or have bariatric surgery results in measurable health benefits (32,33). The health benefits of treating obese patients are discussed in more detail in other parts of this book. Perhaps as physicians gain broader experience in the treatment of obese patients and health care delivery systems invest in the management of this chronic disorder, this unfortunate circumstance will change. Obesity is a diagnosis that is easy to make and one for which proven treatment modalities exist (34).

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