Original Article

Do Physicians Underrecognize Obesity?

Authors: Rachana Thapa, MD, Jennifer Friderici, MS, Reva Kleppel, MSW, MPH, Jan Fitzgerald, MS, RN, Michael B. Rothberg, MD, MPH


Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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1. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief 2012;82:1-8.
2. Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010;363:2211-2219.
3. Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013;309:71-82.
4. Rutledge T, Groesz LM, Linke SE, et al. Behavioural weight management for the primary care provider. Obes Rev 2011;12:e290-e297.
5. Sivalingam SK, Ashraf J, Vallurupalli N, et al. Ethnic differences in the self-recognition of obesity and obesity-related comorbidities: a cross-sectional analysis. J Gen Intern Med 2011;26:616-620.
6. Thande NK, Hurstak EE, Sciacca RE, et al. Management of obesity: a challenge for medical training and practice. Obesity (Silver Spring) 2009;17:107-113.
7. Schriefer SP, Landis SE, Turbow DJ, et al. Effect of a computerized body mass index prompt on diagnosis and treatment of adult obesity. Fam Med 2009;41:502-507.
8. Ruser CB, Sanders L, Brescia GR, et al. Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med 2005;20:1139-1141.
9. Bordowitz R, Morland K, Reich D. The use of an electronic medical record to improve documentation and treatment of obesity. Fam Med 2007;39:274-279.
10. Bardia A, Holtan SG, Slezak JM, et al. Diagnosis of obesity by primary care physicians and impact on obesity management. Mayo Clin Proc 2007;82:927-932.
11. Melamed OC, Nakar S, Vinker S. Suboptimal identification of obesity by family physicians. Am J Manag Care 2009;15:619-624.
12. Centers for Disease Control and Prevention. QuickStats: prevalence of obesity (class I, II, and III)* among adults aged Q20 years, by age group and sex-National Health and Nutrition Examination Survey, United States, 2007Y2008. MMWR Morb Mortal Wkly Rep 2010;59:527.
13. Lemay CA, Cashman S, Savageau J, et al. Underdiagnosis of obesity at a community health center. J Am Board Fam Pract 2003;16:14-21.