Wisconsin physician survey on diagnosis and treatment of obesity

Obesity is an expensive and substantially under-managed condition.  The literature suggests that obesity is not always addressed during a patient visit and is infrequently documented in the patient’s problem list (PL) despite screening and interventional recommendations.  The literature supports that physician interest and referral has a positive effect on weight reduction strategies.  We conducted a cross sectional email solicitation of Wisconsin physicians to complete a survey on their knowledge, perceptions, and practices regarding obesity.  Survey questions included obesity causes, definition, frequency, documentation and barriers to documentation, available consultation time, treatments used and barriers to treatment, and training in obesity management. From over 12,000 e-mails sent from the Wisconsin Medical Society, 590 responses were obtained.  Primary care physicians represented 61% of all respondents, and EMRs were used in 94% of their practices.  Over 90% of respondents accurately identified obesity causes such as diet and activity level.  Family support, lack of knowledge about nutrition, depression, and stress were recognized as obesity causes by over 80% of respondents.  Eighty one percent of respondents identified a BMI of >30 as obese, and 71% of respondents correctly identified that 21-50% of the population is obese.  Physicians reported documentation failure of obesity in the PL for a variety of reasons including treatment unavailability, lack of reimbursement, expense, and lack of effectiveness.  Embarrassment discussing obesity and patient factors were reported by 19% of respondents, and 15% reported failing to document obesity due to lack of pertinence to the visit.  Time spent readdressing obesity at subsequent patient visits was limited to 6 minutes or less for 77% of respondents.  Referrals were most commonly made to dietitians and bariatric surgeons, but only 12% of respondents reported always or sometimes making referrals. Only 14% of respondents were optimistic about sustained weight loss, and only 7% believe they have been successful at treating obesity.  Training in obesity management was reported to have occurred in 6% of medical school experiences and in 10% of respondent’s residency training.  The effectiveness of physician obesity interventions may be improved by several steps.  Training in obesity management during medical school and residency may improve patient outcomes.  The majority of respondents stated they would be interested in receiving training in obesity management, and the majority also reported lacking sufficient tools to assist in obesity management.  Reducing the barriers to documentation and treatment could improve the rate of referral and enhance success in obesity management.