Clothier N, Marvel K, Cruickshank C. Does presenting patients’ BMI
increase documentation of obesity?
difference in documentation rates between the two
physician groups was not statistically significant (t
(df = 6)= .809, p= .434). The mean documentation
rate of physicians in the experimental group was
30.4%, compared to 22.0% in the control group.
Physicians in the experimental group were more
likely to document obesity following the intervention
(30.4%) than before the intervention (24.1%) al-
though, again, this difference was not statistically
significant (t (df = 6)=-.737, p= .489).
Of the 688 charts reviewed, 168 (24.4%) had a
BMI in the “overweight” range (25-28 for women,
26-29 for men), and 201 (29.2%) had a BMI in the
“obese” range. In sum, over half (53.6%) of the
patients measured during the study were above the
“desirable” range.
Discussion
The intervention of routinely listing the BMI
along with other vital signs did not result in a
significant increase in the documentation of obesity
in the medical record. Indeed, the rate of
documentation was quite low for physicians in both
the experimental and control groups. There are
several possible explanations for the lack of
effectiveness of the intervention. Possibilities
include those described in the introduction, such as
the lack of a clear protocol to deal with obesity, or
the need for more potent interventions.
Listing conditions on the medical chart has been
shown to increase physician attention to other
problems.7 A previous study which placed smoking
status on the vital signs was shown to significantly
increase physician discussion with patients about
their smoking habit. That intervention may have been
more effective than the present BMI listing due to the
nature of the topic. That is, discussion of patient
smoking habits by the physician may be perceived as
less sensitive than discussions of weight. In the
present study, the perceived sensitivity of the topic
may have deterred physicians from addressing the
issue. Research has shown that physicians are
reluctant to counsel patients about weight for several
reasons: 1) inadequate training in counseling obese
patients, 2) lack of time, 3) perceived inability to
change patient behavior, 4) disbelief in the
importance of preventive counseling, and 5)
perceived lack of patient concern.4 Obesity is
common in this patient population and underscores
the need for an effective way to identify and
intervene with this medical problem.
Med Educ Online [serial online] 2002;7:6. Available from URL
http://www.med-ed-online.org
There are several limitations to this study. First,
we relied exclusively on chart audit for data
collection. Physicians may have discussed obesity
with the patient, but did not document that discussion
in the chart. Second, our data collection was
performed in a family medicine residency program.
This may limit the ability to generalize these results
to physicians in a private practice setting. Another
limitation in using the residency program is attrition
of physicians due to graduation from the residency
program, resulting in less post-intervention data.
Finally, the small sample size may have obscured
statistically significant differences due to a lack of
power.
Because of the importance of obesity in disease,
further study and innovative ideas must be advanced
to increase physician recognition and documentation
of obesity to improve its management in their
patients.
Acknowledgements
The authors wish to thank Mike Scardaville, Jason
Lebsack, and Kristen Brezinski for their assistance
with data gathering and analysis.
References
1. U.S. Department of Health and Human Services.
The Surgeon General’s call to action to prevent
and decrease overweight and obesity. [Rockville,
MD]: U.S. Department of Health and Human
Services, Public Health Service, Office of the
Surgeon General; [2001]. Available from: US
GPO, Washington.
2. U.S. Department of Health and Human Services.
National Heart Lung and Blood Institute. Clinical
Guidelines on the Identification, Evaluation, and
Treatment of Overweight and Obesity in Adults
Washington: Government Printing Office, 1998.
3. Rippe JM, McInnis KJ & Melanson KJ.
Physician Involvement in the Management of
Obesity as a Primary Medical Condition. Obesity
Research. 2001;9: S302-S31.
4. Nawaz H, Adams ML, & Katz DL. Weight loss
counseling by health care providers. American
Journal of Public Health.. 1999;89.5:764-767.
5. Sciamanna CN. Tate DF. Lang W & Wing RR.