Effect of a BMI chart on weight management discussions in a primary care setting.

OBJECTIVE: To measure whether the addition of a BMI chart to a patient's medical record at the time of the office visit would increase the likelihood of a physician discussing weight management with the patient. METHODS: Office staff were instructed to place a BMI chart on the front of medical charts of all patients aged 21 years to 65 years who were seen during a 2-month period in two urban university-affiliated clinics. The staff were to plot the BMI on the chart. The medical records were audited for the presence of the BMI chart and any documentation of a discussion of weight management. RESULTS: Of the 961 charts that were audited, 44% contained the BMI chart. A discussion of weight management issues was documented in 19% of those that contained a BMI chart and in 15% of those that did not contain a BMI chart. CONCLUSIONS: Data presented here suggest that adding a BMI chart to the patient medical record may increase the attention of a physician to weight management issues.

Gastric bypass surgery in the United States, 1998-2002.

We assessed the prevalence of gastric bypass surgeries in the United States on the basis of data from the 1998 to 2002 National Hospital Discharge Survey. Between 1998 and 2002, rates (per 100,000 adults) increased significantly (P<.001): from 7.0 to 38.6. This observed increase in the rate of gastric bypass surgery for the treatment of obesity may be attributed in part to improvements in surgical technique, improved patient outcomes, and increased popularity of this procedure.

Increasing awareness of obesity as a treatable medical condition.

OBJECTIVE: To estimate the prevalence of overweight and obesity in a population comprised of patients seen at two local primary care clinics and to evaluate the management of this epidemic in a primary care setting. METHODS: Patient medical charts from two urban community clinics in Louisville, Kentucky, were reviewed to determine how the diagnosis of overweight and obesity was assessed and treated. RESULTS: The estimated prevalence of obesity in this population was 40.2% as compared to the national statistics of 30.5%. Despite the higher percentage of obesity, less advice regarding weight loss was given to the patient group under study (30.5%) compared to national survey estimates (42% advised to lose weight and 34% counseled on physical activity). CONCLUSIONS: Data presented here suggest that patients within this Kentucky urban primary care community have not received adequate obesity advice from their physician. Obesity is a growing concern and must be addressed by increasing awareness.

Communication between family physicians and registered dietitians in the outpatient setting.

OBJECTIVE: To elicit how registered dietitians and family physicians communicate in the outpatient setting. DESIGN: A descriptive pilot study using two mailed surveys was conducted to elicit aspects of outpatient communication between registered dietitians and family physicians. A sample of nutrition correspondence from registered dietitians to family physicians was also requested. SUBJECTS: Surveys were distributed to 504 licensed dietitians and 626 family physicians. STATISTICAL ANALYSES: Descriptive statistics were used to analyze survey results. RESULTS: Responses were received from 389 registered dietitians (77% return rate) and 235 family physicians (37.5% return rate). We received 104 sample notes of correspondence with physicians from dietitians. Among dietitians, 80% reported that they always assess a patient's lifestyle and educational level before choosing an educational approach, and 69% send the nutrition treatment plan to the referring family physician. Among family physicians, 49% often or always find the communications they receive from registered dietitians to be helpful. However, 41% of family physicians reported that they rarely receive detailed nutrition assessments or recommendations about the referred patient from the dietitian, and 54% of all family physicians surveyed often think that this lack of feedback compromises patient care. APPLICATIONS/CONCLUSION: Dietitians can improve communications with family physicians by standardizing the format and focus of nutrition correspondence and assuring that the referring family physician receives the patient's nutrition care plan. These simple changes would close a very important communication loop, forge stronger partnerships between dietitians and family physicians, and potentially improve patient outcomes.