Documentation and Treatment of Obesity in Primary Care Physician Office Visits: The Role of the Patient-Physician Relationship.

INTRODUCTION: An ongoing patient-physician relationship may increase the likelihood of acknowledging obesity and providing a treatment plan. The purpose of the study was to investigate if continuity of care was associated with recording of obesity and receipt of a weight-loss treatment plan. METHODS: We analyzed data from the 2016 and 2018 National Ambulatory Medical Care Survey. Only adult patients with measured body mass index of ≥ 30 were included. Our primary measures were acknowledgment of obesity, treatment of obesity, continuity of care, and obesity-associated comorbid conditions. RESULTS: Among patients who were objectively obese, only 30.6% had an acknowledgment of the patient's body composition in the visit. In adjusted analyses, continuity of care was not significantly related to recording of obesity but did significantly increase the likelihood of treatment for obesity. Continuity of care was only significantly related to obesity treatment when defined as a visit with the patient's established primary care physician. The effect was not seen with continuity with the practice. DISCUSSION: There are many missed opportunities for prevention of obesity-related disease. Continuity of care with a primary care physician was associated with benefits in treatment likelihood, but greater emphasis on managing obesity in a primary care visit seems warranted.

Body composition among adults at a healthy body mass index and association with undetected non-alcoholic fatty liver.

BACKGROUND: Adults with a healthy Body Mass Index but elevated body fat are at risk for a variety of undetected metabolic problems. It is unclear whether non-alcoholic fatty liver is associated with this body type. PARTICIPANTS/METHODS: Associations between elevated body fat and non-alcoholic fatty liver disease (NAFLD) among adults with a healthy Body Mass Index (18.5-24.9) were assessed. A cohort of healthy BMI, non-pregnant, adults without history of liver disease or recent heavy drinking was constructed from the NHANES 2017-2018 survey. Body fat percentages were determined from whole-body DXA scans. Liver ultrasound transient elastography indicated the presence of hepatic steatosis. RESULTS: A significantly larger proportion of adults with an elevated body fat % (46.2%) than those with a healthy body fat % (25.1%) (p = 0.002) had undiagnosed NAFLD. In a logistic regression adjusted for age, sex, race/ethnicity, and exercise, hepatic steatosis was associated with an elevated body fat percentage within the cohort of adults with a healthy BMI (OR 3.51; 95% CI 2.11-5.86). CONCLUSION: The usefulness of alternative body composition measures should be considered when screening for NAFLD.