Obesity in ambulatory care

Despite the focus on health and fitness over the past decade, the incidence of obesity is increasing in the United States. Obesity, when existing as a comorbid medical problem, complicates the management of many conditions. Using a body mass index (BMI) of >30kg / m2 to define obesity we found a 54% prevalence of obesity in our internal medicine clinics (n = 1160 patient visits). Housestaff appeared to pay little attention to obesity as a medical problem. We devised this study to define the frequency with which the following factors were documented: 1) obesity as part of the interview or physical exam; (2) obesity as a distinct problem in the problem list or assessment; (3) specific intervention noted for obesity; (4) presence of other medical problems known to be complicated by obesity. We reviewed 1234 randomly selected patient visits in an internat medicine resident clinic. Obesity (BMI > 30 kg/m2) was identified in 55.6% of patients, and clinic notes of 271 of these patients were randomly selected for detailed review. Obesity was documented in the history or physical exam in 30% of patients. In 8% of notes, obesity was documented as a distinct problem in the assessment. Any form of intervention (eg; counseling, dietician referral) directed specifically at obesity was documented in 7% of patient visits. Nutritional interventions directed at other disease processes (eg; diet for hyperlipidemia) were noted in 11% of charts. Of the 271 obese patients under review, 65% had hypertension and 37% had diabetes. The prevalence of obesity in our clinic population is higher than that reported for the general population. Documentation of obesity as an independent medical condition is infrequent. Intervention directed towards improvement of obesity is rare. Studies have shown that moderate reductions in body weight can improve control of several medical conditions including hypertension and diabetes. Teaching physicians to recognize obesity as a distinct problem with considerable comorbidity will provide a basis for intervention and improved patient care.