The Effectiveness of Screening for Obesity in Primary Care: Weighing the Evidence

'A beautiful show of strength': weight loss and the fat activist self

This article explores the disciplinary and productive effects of late 20th-century/early 21st-century discourse around the obesity epidemic. For my purposes, both the Fat Activist and Weight Loss Surgery patient may be seen as outcomes of this discursive proliferation. Based on a content analysis of two online accounts of weight loss by prominent fat activists, I examine the ways in which such public declarations can be seen as contemporary examples of Foucault's notion of the confession. Through debates in the 'fatosophere', such activists and their peers simultaneously take up and reject both biomedical and fat activists tenets in ways that are highly ambivalent. In the process, fat activism unsettles and resituates its borders and boundaries and the issue of weight loss becomes a discursive technique of knowledge/power for the understanding of and relating to the fat activist self.

The obesity epidemic: scope of the problem and management strategies

As the obesity epidemic increases, primary care clinicians are encountering obesity and health problems associated with obesity more frequently than ever before. In 2007, 41% of women were classified as obese, with a body mass index (BMI) of 30 or higher. Non-Hispanic blacks and Hispanics are more likely to be obese than white, non-Hispanics. A wide spectrum of health problems has been associated with obesity, including cardiovascular disease, diabetes, metabolic syndrome, osteoarthritis, and polycystic ovary syndrome. Obesity has been shown to be a low-grade inflammatory state, which may be responsible for many of the comorbidities. The general consensus recommends screening for obesity and counseling to promote weight loss. In some cases, pharmacotherapy and or bariatric surgery may be recommended.

Impact of USPSTF practice guidelines on clinician weight loss counseling as reported by obese patients

OBJECTIVES

This study assessed the impact of the US Preventive Services Task Force (USPSTF) guidelines recommending that clinicians provide weight loss counseling (WLC) to all their obese patients.

METHODS

Pre-guideline (n=5524) and post-guideline (n=11,569) datasets were constructed from 2000 and 2005 Behavior Risk Factor Surveillance System survey data from eleven states which administered the weight control module in both years. Responses from obese (BMI> or =30), non-pregnant adults who had a check-up in the previous year were analyzed to determine proportion reporting WLC in the two surveys. Associations of WLC with selected demographics and health characteristics were examined, as well as with reports of weight loss efforts.

RESULTS

Less than half of both pre- and post-guideline obese respondents reported receiving WLC from their clinician. There were no significant differences in adjusted odds of receiving WLC when comparing pre-guideline and post-guideline data. Obese respondents reporting WLC also had higher odds of reporting current efforts to lose weight compared to those reporting no WLC.

CONCLUSIONS

The results suggest the USPSTF obesity-related guidelines have had little impact on clinician WLC behavior. Interventions to improve WLC by clinicians for their obese patients should be developed as practice guidelines alone do not appear to elicit appropriate counseling behavior.

Trends in Obesity-Related Counseling in Primary Care: 1995–2004

OBJECTIVE

We sought to ascertain whether the percentage of visits in which physicians provided obesity-related counseling services increased between 1995 and 2004.

METHOD

Data came from the 1995 to 2004 National Ambulatory Medical Care Survey, an annual national survey of visits to office-based physicians. Analyses are restricted to visits by adults to a primary care physician (PCP; general/family or internal medicine). The main outcome measure is the percentage of visits to physicians where patients were counseled about exercise, diet/nutrition or weight loss.

RESULTS

Sample sizes ranged from 9,583 to 14,071. In 2003/2004, approximately 20% of visits to PCPs included counseling for diet/nutrition, 14% for exercise, and 6% for weight loss. Approximately 24% of visits included at least one of these types of counseling. The odds of receiving counseling for any of these services were 22% lower in 2001/2002 and 18% lower in 2003/2004 compared with 1995/1996. Patients who went to the doctor for weight-related concerns or with an obesity-related diagnosis were more likely to receive counseling than the general population. Longer visits were associated with greater probability of obesity-related counseling.

CONCLUSIONS

Obesity-related counseling does not appear to be a substantial part of the services provided by physicians. Further efforts in developing interventions that can be used by physicians and demonstrating their effectiveness within clinical practice are needed.