Journal of General Internal Medicine

, Volume 25, Issue 5, pp 415–422

From the Patient’s Perspective: The Impact of Training on Resident Physician’s Obesity Counseling

  • Melanie Jay
  • Sheira Schlair
  • Rob Caldwell
  • Adina Kalet
  • Scott Sherman
  • Colleen Gillespie
Original Article

Abstract

BACKGROUND

It is uncertain whether training improves physicians’ obesity counseling.

OBJECTIVE

To assess the impact of an obesity counseling curriculum for residents.

DESIGN

A non-randomized, wait-list/control design.

PARTICIPANTS

Twenty-three primary care internal medicine residents; 12 were assigned to the curriculum group, and 11 were assigned to the no-curriculum group. Over a 7-month period (1–8 months post-intervention) 163 of the residents’ obese patients were interviewed after their medical visits.

INTERVENTION

A 5-hour, multi-modal obesity counseling curriculum based on the 5As (Assess, Advise, Agree, Assist, Arrange) using didactics, role-playing, and standardized patients.

MAIN MEASURES

Patient-report of physicians’ use of the 5As was assessed using a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5As skills performed during the visit). Univariate statistics (t-tests) were used to compare the rate and quality of counseling in the two resident groups. Logistic and linear regression was used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics.

KEY RESULTS

A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (over 70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% vs. 31.2% of 19 possible 5As counseling strategies, p = 0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher quality counseling than those in the control group (std β = 0.18; R2 change = 2.9%, P < 0.05).

CONCLUSIONS

Residents who received an obesity counseling curriculum were not more likely to counsel obese patients than residents who did not. Training, however, is associated with higher quality of counseling when patient, physician, and visit characteristics are taken into account.

KEY WORDS

obesity counseling results 

References

  1. 1.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the united states, 1999–2004. JAMA. 2006;295(13):1549–55.CrossRefPubMedGoogle Scholar
  2. 2.
    McGee DL, Diverse Populations C. Body mass index and mortality: A meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol. 2005;15(2):87–97.CrossRefPubMedGoogle Scholar
  3. 3.
    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Larsson SC, Wolk A. Overweight and obesity and incidence of leukemia: A meta-analysis of cohort studies. Int J Cancer. 2008;122(6):1418–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Burke GL, Bertoni AG, Shea S, et al. The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease: The multi-ethnic study of atherosclerosis. Arch Intern Med. 2008;168(9):928–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.see comment. N Engl J Med. 2002;346(6):393–403.CrossRefPubMedGoogle Scholar
  7. 7.
    Loureiro ML, Nayga RM Jr. Obesity, weight loss, and physician’s advice. Soc Sci Med. 2006;62(10):2458–68.CrossRefPubMedGoogle Scholar
  8. 8.
    Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians’ weight loss counseling in two public hospital primary care clinics. Acad Med. 2004;79(2):156–61.CrossRefPubMedGoogle Scholar
  9. 9.
    Ockene IS, Hebert JR, Ockene JK, et al. Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester area trial for counseling in hyperlipidemia (WATCH). Arch Intern Med. 1999;159(7):725–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Martin PD, Dutton GR, Rhode PC, Horswell RL, Ryan DH, Brantley PJ. Weight loss maintenance following a primary care intervention for low-income minority women. Obesity. 2008;16(11):2462–7.CrossRefPubMedGoogle Scholar
  11. 11.
    U.S. Preventive Services Task Force. Screening for obesity in adults. Recommendations and rationale. See comment. Ann Intern Med. 2003;139(11):930–2.Google Scholar
  12. 12.
    Grundy SM, Balady GJ, Criqui MH, et al. Guide to primary prevention of cardiovascular diseases. A statement for healthcare professionals from the task force on risk reduction. American Heart Association science advisory and coordinating committee. Circulation. 1997;95(9):2329–31.PubMedGoogle Scholar
  13. 13.
    Klein S, Sheard NF, Pi-Sunyer X, et al. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: Rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Am J Clin Nutr. 2004;80(2):257–63.PubMedGoogle Scholar
  14. 14.
    Nawaz H, Adams ML, Katz DL. Weight loss counseling by health care providers. Am J Public Health. 1999;89(5):764–7.CrossRefPubMedGoogle Scholar
  15. 15.
    O’Brien SH, Holubkov R, Reis EC. Identification, evaluation, and management of obesity in an academic primary care center. Pediatrics. 2004;114(2):e154–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Scott JG, Cohen D, DiCicco-Bloom B, et al. Speaking of weight: How patients and primary care clinicians initiate weight loss counseling. Prev Med. 2004;38(6):819–27.CrossRefPubMedGoogle Scholar
  17. 17.
    Block JP, DeSalvo KB, Fisher WP. Are physicians equipped to address the obesity epidemic? knowledge and attitudes of internal medicine residents. Prev Med. 2003;36(6):669–75.CrossRefPubMedGoogle Scholar
  18. 18.
    Kushner RF. Barriers to providing nutrition counseling by physicians: A survey of primary care practitioners. Comment. Prev Med. 1995;24(6):546–52.CrossRefPubMedGoogle Scholar
  19. 19.
    Jay M, Gillespie C, Ark T, et al. Do internists, pediatricians, and psychiatrists feel competent in obesity care? using a needs assessment to drive curriculum design. JGIM. 2008;23(7):1066–1070.CrossRefPubMedGoogle Scholar
  20. 20.
    Serdula MK, Khan LK, Dietz WH. Weight loss counseling revisited. JAMA. 2003;289(14):1747–50.CrossRefPubMedGoogle Scholar
  21. 21.
    Glasgow RE, Emont S, Miller DC. Assessing delivery of the five ‘As’ for patient-centered counseling. Health Promot Int. 2006;21(3):245–55.CrossRefPubMedGoogle Scholar
  22. 22.
    Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: An evidence-based approach. Am J Prev Med. 2002;22(4):267–84.CrossRefPubMedGoogle Scholar
  23. 23.
    Unrod M, Smith M, Spring B, DePue J, Redd W, Winkel G. Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. J Gen Intern Med. 2007;22(4):478–84.CrossRefPubMedGoogle Scholar
  24. 24.
    Lamb R, Joshi MS. The stage of change model and processes of change in dietary fat reduction. J Hum Nutr Diet. 1996;9(1):43–53.CrossRefGoogle Scholar
  25. 25.
    Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.PubMedGoogle Scholar
  26. 26.
    Ware J, Snyder M, Wright W. Development and validation of scales to measure patient satisfaction with medical care services. vol I, part B: Results regarding scales constructed from the patient satisfaction questionnaire and measures of other health care perceptions. Springfield, VA: National Technical Information Service; 1976.Google Scholar
  27. 27.
    Marshal G, Hays RS. The patient satisfaction questionnaire short form (PS-18). California: Rand Publications; 1994.Google Scholar
  28. 28.
    Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. Shared decision making: Developing the OPTION scale for measuring patient involvement. Qual Saf Health Care. 2003;12(2):93–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Campbell MK, Thomson S, Ramsay CR, MacLennan GS, Grimshaw JM. Sample size calculator for cluster randomised trials. Comput Biol Med. 2004;34:113–25.CrossRefPubMedGoogle Scholar
  30. 30.
    Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults--the evidence report. national institutes of health. Obes Res. 1998 Sep; 6 Suppl 2:51S-209S.Google Scholar
  31. 31.
    Ruser CB, Sanders L, Brescia GR, et al. Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med. 2005;20(12):1139–41.CrossRefPubMedGoogle Scholar
  32. 32.
    Chernof BA, Sherman SE, Lanto AB, Lee ML, Yano EM, Rubenstein LV. Health habit counseling amidst competing demands: Effects of patient health habits and visit characteristics. Med Care. 1999;37(8):738–47.CrossRefPubMedGoogle Scholar
  33. 33.
    Henderson JT, Weisman CS. Physician gender effects on preventive screening and counseling: An analysis of male and female patients’ health care experiences. Med Care. 2001;39(12):1281–92.CrossRefPubMedGoogle Scholar
  34. 34.
    LeCheminant JD, Jacobsen DJ, Hall MA, Donnelly JE. A comparison of meal replacements and medication in weight maintenance after weight loss. J Am Coll Nutr. 2005;24(5):347–53.PubMedGoogle Scholar
  35. 35.
    Carek PJ, Dickerson LM, Boggan H, Diaz V. A limited effect on performance indicators from resident-initiated chart audits and clinical guideline education. Fam Med. 2009;41(4):249–54.PubMedGoogle Scholar
  36. 36.
    Hrisos S, Eccles MP, Francis JJ, et al. Are there valid proxy measures of clinical behaviour? a systematic review. Implement Sci. 2009;4:37.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Melanie Jay
    • 1
  • Sheira Schlair
    • 3
  • Rob Caldwell
    • 1
  • Adina Kalet
    • 1
  • Scott Sherman
    • 1
    • 2
  • Colleen Gillespie
    • 1
  1. 1.Division of General Internal MedicineNew York University School of MedicineNew YorkUSA
  2. 2.Veterans Affairs New York HarborNew YorkUSA
  3. 3.Division of General Internal Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronxUSA

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