Improving Obesity Management in a Primary Care Setting

Background: Obesity is a complex chronic condition that increases a patient's risk for many other chronic conditions. Although screening for obesity has increased in recent years, weight counseling in primary care is not ubiquitous due, in part, to providers' lack of knowledge and confidence in discussing obesity treatment options. The purpose of this project was to improve primary care providers' confidence and knowledge in discussing weight management with patients, leading to an increase in discussions about obesity treatment options. Methods: An evidence-based practice project was developed after assessing the needs of the primary care providers (PCPs) at a single primary care clinic serving undergraduate and graduate students of a large state University. An educational PowerPoint presentation was given at a staff meeting, and providers were given an evidence-based clinical practice guideline (CPG) to be used in everyday practice. The PCPs were surveyed pre and post-intervention about knowledge and comfort in treating obesity, beliefs about causes of obesity and treatment, and questions regarding implicit and explicit obesity bias. Pre and post-intervention surveys were compared for change at the group level. A chart review was conducted pre and post-intervention to compare the difference in the use of obesity and obesity counseling ICD-10 codes. Results: The PCPs surveyed self-reported more confidence and knowledge in treating obesity after the educational presentation and implementation of the CPG. The PCPs acknowledged that obesity is a multifaceted condition with many contributing factors; however, their weighted importance of different factors changed pre and post-implementation. Overall, the providers showed less bias towards patients with obesity post-implementation. Although there was an increase in both obesity associated diagnosis codes used during the implementation period, there was not a statistically significant difference between the use of obesity diagnosis codes ( p = .42) of obesity counseling codes (p = .06) used between the pre-implementation and implementation periods. The PCPs surveyed, as a group, did not feel comfortable prescribing medication for weight loss after the intervention. More education and support could be used in this area. Conclusions: The primary care providers who participated in the project agreed that the CPG was beneficial to their clinical practice, and they felt more confident and knowledgeable about the treatment of obesity in primary care after the project concluded. The amount of change seen in this study was less than what was expected, and points to the need for more education on evidence-based options for obesity treatment in primary care to improve PCPs' ability to discuss and help manage weight loss for patients with obesity.