The National Ambulatory Medical Care Survey, which collects information about the provision and use of outpatient medical care services in the United States, was used for the study. The team analysed survey date for the years 1995-1996 and 2007-2008, as the 2007-08 data was the most recent available at the time of the study, and the survey structure was similar for both years so it provided better comparisons.
The results were that patients who were seen in 2007-08 had a 46% lower chance of receiving weight counselling, even though the percentage of adults who were overweight or obese increased from 52.1% in 1995 to 63.3% in 2008. Only 6.2% of visits in the latter year resulted in counselling. Dr. Jennifer Kraschnewski, assistant professor of medicine, admitted her shock at the results: ‘It is striking that the odds of weight loss counselling declined by 41 percent, with only 29.9 percent of obese patients receiving counselling in 2007-2008, given the substantial increases in the rates of overweight and obesity during that time’.
Still the shocking news did not end there, as high-risk obesity patients, who could most benefit from weight counselling, were less likely to receive it. Those who suffered from high blood pressure were 46% less likely to receive weight counselling, and for diabetes patients this was even worse at 59%. Kraschnewski said this was perhaps the greatest shame of all, as ‘People with these conditions stand the most to gain from the weight counselling’.
Even though evidence shows that counselling is a vital component in helping adults lose weight and keep it off, and the U.S. Preventive Services Task Force recommended that physicians screen all patients for obesity and offer counselling and interventions to promote sustained weight loss in 2003, ‘Unfortunately, other studies have shown that physicians do not conduct weight and weight-related counselling for the majority of their affected patients,’ Kraschnewski said.
The reasons why remain unclear, but the team speculated it could be due to pessimism that patients can change (especially as obesity rates have risen in spite of weight counselling), time and financial limitations or physicians’ doubt about the adequacy of their training for lifestyle counselling.