Patient weight counseling choices and outcomes following a primary care and community collaborative intervention
Introduction
More Americans than ever before are overweight or obese, creating a daunting public health issue that cuts across age, gender, and ethnic domains in our society. Currently, 33% of adults are overweight and 34% are obese; data that represent the significant increases in overweight prevalence rates from 1988 to 2004 [1], [2]. As such, this national epidemic requires immediate action and novel solutions to slow the current trajectory. Reducing obesity will require new perspectives and significant changes in the way the problem is addressed by physicians, researchers, parents, public health institutions, and community groups. Clinicians and practices, as systems of care, face a growing need to offer patients high-quality resources on health behavior change and health promotion strategies; yet, medical practices may lack the time and resources to thoroughly assess the health behaviors of patients, their readiness to change, or the type of assistance they need [3], [4].
Having been encouraged by clinicians to improve health habits, patients often seek additional resources regarding techniques, motivational strategies, and community programs. However, studies show that only 65% of obese patients receive the advice they seek on weight loss [5]. Physician organizations and practice groups are proactively developing and testing new approaches for addressing overweight and obesity in patients who need more structure, motivation, and resources [6].
The use of the electronic medical record (EMR) provides clinicians with technology to easily identify patients with unhealthy behaviors, a counseling platform such as the 5 A's (Assess, Advise, Agree, Assist, Arrange) [10], and the ability to automate referrals to outside health behavior counseling services [7], [8]. EMRs can be programmed to identify patients who smoke or are overweight and prompt clinicians to initiate counseling about improving health behaviors. Such features can be valuable for identifying groups of patients who would benefit from more intensive counseling through referral to community resources [9]. More research is needed to assess and evaluate the features of low-intensity interventions that most practices could potentially deliver.
Section snippets
eLinkS intervention
This study was part of the Prescription for Health initiative, sponsored by the Robert Wood Johnson Foundation, to study new approaches of addressing unhealthy lifestyle behaviors in primary care practices [12]. Details of the study intervention are reported elsewhere [11]. Briefly, this study tested a clinician-delivered (clinicians included physicians, physician assistants, and nurse practitioners) intervention (eLinkS) that utilized an EMR-based prompt and referral system to identify adult
Demographic characteristics and selection of weight counseling programs
Demographic characteristics are shown for the study sample and by group in Table 1. The mean age of the participants was 57 years old and 70% of the sample was female. The sample included minorities (28%), low-income patients (36%), and a large representation of persons with no college education (41%).
Of the three weight loss counseling options, group classes (WW) were the most popular counseling choice (n = 83), followed by usual care (n = 39) and telephone counseling (n = 24). The counseling groups
Discussion
Research documents the need for testing new clinician-based interventions to help patients improve health behaviors [17], [18], [19], [20], [21]. In this study, patients referred to weight loss counseling overwhelmingly preferred group classes (WW) to telephone counseling and usual care. This preference was so substantial that intervention intake reached maximum capacity after only 5 weeks. Some features of the counseling programs and characteristics of our sample may have contributed to this
Acknowledgements
The authors thank the practices in Riverside Medical Group that participated in this study: Bruton Avenue Family Medicine, Eagle Harbor Primary Care, Elizabeth Lakes Family Practice, Hilton Family Practice, Mathews Medical Center, Mercury West Medical Center, Patriot Primary Care, Riverside Family Medicine, and Williamsburg Medical Arts Family Practice. We also thank the staff of Weight Watchers™ International, Riverside Wellness Center, and the University of Kentucky Health &Wellness Behavior
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