Hindsight: Recognition and Management of Obesity in Primary Care

In 2004, we published the results of a study in the International Journal of Obesity, looking at recognition and management of overweight and obese patients in primary care settings across Germany.

The goals of this study were to examine (1) the point prevalence of overweight and obesity in primary care patients, (2) prevalence patterns in patients with high-risk constellations (diabetes, hypertension, cardiovascular disease, etc.), (3) doctors’ recognition and interventions, as well as patients’ use and perceived effectiveness of weight-loss interventions and (4) factors associated with non-treatment.

This cross-sectional study included 45,125 unselected consecutive primary care attendees recruited from a representative nationwide sample of 1912 primary care practices across Germany.

While almost 40% of all primary care attendees were overweight, 20% were obese.

Rates for overweight and obesity were highest in patients with diabetes (43.6 and 36.7%) and hypertension (46.1 and 31.3%).

Rates of overweight/obesity increased steadily by the number of comorbid conditions.

Doctors’ recognition of overweight (20-30%) and obesity (50-65%) was low, and patients’ actual use of weight control interventions even lower (past 12 months: 8-11%, lifetime: 32-39%).

Co- and multimorbidity were predictors for better recognition of obesity but did not appear to have a noticeable influence on the use of any weight-loss interventions.

Thus, back in 2004, this representative sample of German primary care patients showed a high prevalence of overweight and obesity but primary care management of excess weight was largely non-existent.

The key factors for this lack of intervention was predominantly due to doctors’ poor recognition of patients’ weight status, doctors’ inefficient efforts at intervention, patients’ poor acceptance of such interventions, and general dissatisfaction with existing life-style modification strategies.

It is probably fair to say that in the past eight years probably not much has changed and a similar study today will likely produce very similar results.

As in 2004, doctors today, are probably no more vigilant or enthusiastic about recognising and managing obesity than back then.

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Valemount, BC