Thapa Rachana, Friderici Jennifer, Kleppel Reva, Fitzgerald Jan, Rothberg Michael B
From the Departments of Internal Medicine and Academic Affairs Administration, Baystate Medical Center, Springfield, Massachusetts, and Cleveland Clinic, Cleveland, Ohio.
South Med J. 2014 Jun;107(6):356-60. doi: 10.14423/01.SMJ.0000450707.44388.0c.
A physician's advice is among the strongest predictors of efforts toward weight management made by obese patients, yet only a minority receives such advice. One contributor could be the physician's failure to recognize true obesity. The objectives of this study were to assess physicians' ability to recognize obesity and to identify factors associated with recognition and documentation of obesity.
Internal medicine residents and attending physicians at three academic urban primary care clinics and their adult patients participated in a study using recognition and documentation of patient obesity as the main measures.
A total of 52 physicians completed weight assessments for 400 patients. The mean patient age was 51 years, 56% were women, 77% were Hispanic, and 67% had one or more obesity-related comorbidity. There were 192 (48%) patients, of whom 66% were correctly identified by physicians as being obese, 86% of those with a body mass index (BMI) ≥ 35, but only 49% of those with a BMI of 30 to 34.9 (P < 0.0001). Fewer obese Hispanic patients were identified than were non-Hispanic patients (62% vs 76%; P = 0.03). No physician characteristics were significantly associated with recognition of obesity. Physicians documented obesity as a problem for 51% of patients. Attending physicians documented obesity more frequently than did residents (64% vs 43%, odds ratio 2.5, 95% confidence interval 1.3-4.6) and normal-weight physicians documented obesity more frequently than overweight physicians (58% vs 41%, odds ratio 2.0, 95% confidence interval 1.0-4.0). Documentation was more common for patients with a BMI ≥ 35 and for non-Hispanics. Documentation was not more common for patients with obesity-related comorbidities.
Physicians have difficulty recognizing obesity unless patients' BMI is ≥ 35. Training physicians to recognize true obesity may increase rates of documentation, a first step toward treatment.
医生的建议是肥胖患者进行体重管理努力的最强预测因素之一，但只有少数患者能得到此类建议。一个原因可能是医生未能识别真正的肥胖。本研究的目的是评估医生识别肥胖的能力，并确定与肥胖识别和记录相关的因素。
三家学术性城市初级保健诊所的内科住院医师和主治医生及其成年患者参与了一项以患者肥胖的识别和记录为主要指标的研究。
共有52名医生为400名患者完成了体重评估。患者的平均年龄为51岁，56%为女性，77%为西班牙裔，67%有一种或多种与肥胖相关的合并症。有192名（48%）患者，其中66%被医生正确识别为肥胖，体重指数（BMI）≥35的患者中有86%被识别，但BMI为30至34.9的患者中只有49%被识别（P<0.0001）。被识别出的肥胖西班牙裔患者少于非西班牙裔患者（62%对76%；P=0.03）。没有医生特征与肥胖识别显著相关。医生将肥胖记录为51%患者的问题。主治医生比住院医师更频繁地记录肥胖（64%对43%，优势比2.5，95%置信区间1.3 - 4.6），体重正常的医生比超重医生更频繁地记录肥胖（58%对41%，优势比2.0，95%置信区间1.0 - 4.0）。对于BMI≥35的患者和非西班牙裔患者，记录更为常见。对于有肥胖相关合并症的患者，记录并不更常见。
除非患者的BMI≥35，医生很难识别肥胖。培训医生识别真正的肥胖可能会提高记录率，这是迈向治疗的第一步。
