Screening and management of obesity and perception of weight status in Medicaid recipients.

OBJECTIVE: We sought to identify any correlations among primary care provider weight screening and counseling, patient weight perception, and weight loss attempt. METHODS: We performed a cross-sectional analysis of obesity-related questions from 2009 and 2010 Kentucky Medicaid Adult Patient and Provider survey data. RESULTS: 1,510 patients [46% obese (body mass index (BMI) ≥30 kg/m2), 26% overweight (BMI 25 to <30), 26% normal weight (BMI 18 to <25), and 2% underweight (BMI<18)] and 787 providers (41% primary care) met criteria. Patients and providers differed on report of physician weight loss counseling (46% versus 92%). Patient report of physician weight loss counseling and weight loss attempt were positively correlated (77% with versus 38% without counseling, p<.01). One-fifth of patients underperceived their weight. Patients reporting physician weight counseling were less likely to underperceive their weight (13% versus 23%, p<.0001). CONCLUSIONS: Weight loss attempt and accurate weight perception were positively correlated with physician weight discussion.

A pilot Internet-based behavioral weight loss intervention with or without commercially available portion-controlled foods.

OBJECTIVE: To evaluate the short-term impact of portion-controlled food provision in combination with an Internet behavioral weight loss program on weight, blood cholesterol, and blood glucose levels. DESIGN AND METHODS: Fifty participants, mean age 46 ± 10.7 years and mean body mass index 35.1 ± 3.8 kg/m2 , were randomized to one of two study groups, an Internet behavioral weight loss program (Internet-alone; n = 25) or an Internet behavioral weight loss program plus a commercially available portion-controlled diet (Internet + PCD; n = 25) for 12 weeks. RESULTS: An intent-to-treat analysis found that the mean weight change in the Internet + PCD group was -5.7 ± 5.6 kg and in the Internet-alone group (n = 25) was -4.1 ± 4.0 kg (P = 0.26). Participants in the Internet + PCD group achieved significantly greater improvements in blood glucose (-2.6 ± 5.7 vs. 1.4 ± 11.0 mg/dl; P = 0.05) and LDL cholesterol (-8.2 ± 18.0 vs. -0.6 ± 21.0 mg/dl; P = 0.04), compared with Internet-alone group. CONCLUSIONS: These data suggest that there may be short-term clinical benefit in using a PCD in conjunction with a behavioral Internet-based weight loss program to enhance weight loss and improve health indicators.

Documentation of body mass index and control of associated risk factors in a large primary care network.

BACKGROUND: Body mass index (BMI) will be a reportable health measure in the United States (US) through implementation of Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network. METHODS: We conducted a cross-sectional analysis of 79,947 active network patients greater than 18 years of age seen between 7/05 - 12/06. We defined BMI category as normal weight (NW, 18-24.9 kg/m2), overweight (OW, 25-29.9), and obese (OB, >or= 30). We measured documentation (yes/no) and control (above/below) of the following three risk factors: blood pressure (BP)