Obesity: Survey Finds Primary Care Providers’ Knowledge “Inconsistent” with Evidence-Based Recommendations

Despite the high prevalence of obesity in the US, a new study finds that providers’ knowledge of evidence-based recommendations for obesity is low.

For example, only 15% were able to identify the “appropriate indication” for prescribing pharmacotherapy for patients: a BMI over 27 with an obesity-associated comorbid condition. Two-thirds said it is appropriate to continue long-term pharmacotherapy under conditions inconsistent with evidence-based guidelines. Providers were “most knowledgeable” regarding the physical activity guidelines, with 49% answering correctly.

In addition, “only 16% of respondents indicated that obesity counseling should be provided approximately twice monthly in an individual or group setting for at least 6 months,” in accordance with U.S. Preventive Services Task Force and CMS guidelines, according to the study by Monique Turner, George Washington University, Milken Institute of Public Health, et al., and published in the journal Obesity. (Shout out to my colleague at GWU, Dr. Monique!)

Overall, providers’ understanding of clinical care for obesity, which includes intensive behavioral therapy, physical activity, and pharmacotherapy, is “inconsistent with evidence-based recommendations” the study found – despite the fact that most health care providers believe they are responsible for ensuring patients are informed about obesity treatments.

Given the current obesity epidemic and the known costs associated with obesity, it seems obvious that primary care physicians should make it a priority to be up-to-date with current treatments and approaches to weight loss and optimal health. This would also help them advocate for better coverage of interventions.

In an accompanying commentary, Robert Kushner, Northwestern University, Feinberg School of Medicine, appears to agree:

“Knowledge of the guidelines is a reasonable objective but is not sufficient to change practice behavior,” Kushner says. Nonadherence to practice guidelines “may be due to other factors independent of knowledge,” including fragmentation of care, disagreement between guidelines, and “external practice barriers.”

He cites the need for effective dissemination and implementation approaches for practice guidelines. He also points out that other educational initiatives are under way “that will impact the practice of obesity in the primary care setting,” for example, through the Obesity Medicine Education Collaborative (OMEC), which is “currently finalizing a set of 32 obesity-specific competencies” as part of undergraduate, postgraduate, and fellowship training. “By taking a continual and comprehensive educational approach, we are on our way to get primary care ready to treat obesity,” he concludes.

Obesity is a growing problem in the U.S. in terms of both health outcomes and costs; in fact, as I’ve about recently, it is also linked to declining mortality improvements in the US compared to other wealthy countries. Unfortunately, despite the availability of a range of non-surgical interventions supported by evidence-based practice guidelines, primary care providers generally are not appropriately trained in this area, nor do they keep pace with new treatment findings on how to address this problem. If we want to tackle the obesity problem and improve health outcomes, life expectancy and costs, we must find ways to address barriers of this kind, and our reimbursement policies will need to incentivize providers to focus on this issue.