Weight Counseling for Elderly Patients in Primary Care: How Often and How Much Time

Article excerpt

ABSTRACT

Some 20 million Americans over the age of 60 will soon be obese. As a result, they will likely suffer lower life-expectancy, higher disability, and higher health care costs. How much time do physicians spend with elders, especially obese elders, in helping them plan weight loss? This study, which analyzed 352 videotaped visits with elderly patients and their provider, has found that only a third of the visibly obese patients were counseled, and that the average time spent discussing the subject--if discussed--was 103 seconds. This is probably less than a fifth of the time needed to adequately counsel patients about weight loss. In addition, the study has found that both provider and patient characteristics determine if and how long discussion lasts.

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The prevalence of obesity in adults aged 60 and older is estimated to increase to 37% by 2010 and thus will affect over 20 million people in the United States (Arterburn, 2004) who as a result are likely to suffer lower life-expectancy, higher disability, and higher health care costs (Lakdawalla, 2005). The US Preventive Services Task Force recommends that physicians screen all adult patients for obesity and that intensive counseling and behavioral interventions be offered to promote sustained weight loss for obese adults (USPSTF, 2003). Similarly, the National Heart Lung and Blood Institute recommends the assessment of weight status at every patient encounter that affords such opportunity, followed by counseling and treatment as needed (NHLBI, 2005). Nevertheless, studies indicate that only about a third of patients who are obese are advised to lose weight (Heath, 1993; Galuska, 1999) and elderly overweight patients may receive even less guidance and intervention.

Time constraints are clearly one obstacle to effective patient counseling and treatment (Yarnall et al., 2003). An average physician office visit lasts from 16 to 18 minutes (Mechanic, McAlpine, & Rosenthal, 2001). Ockene and colleagues reported results from a randomized clinical trial on counseling on dietary fat and cholesterol reduction and showed that effective counseling would take about eight minutes in a primary care setting (Ockene, et al., 1999). That is about half of the average length of an office visit. Studies of patient-physician interaction show that a typical office visit involves the discussion of three topics (Stange, et al., 1998), whereas for elderly it averages six topics (Tai-Seale, McGuire, & Zhang, in press), depending on how topics are defined. The literature is relatively silent, however, on how much time is spent on discussing weight loss among the elderly, and on the characteristics of both patients and providers in this interaction. This paper addresses these issues.

METHODS

Study Sites and Recruitment

Physicians from three locations were chosen to include diverse forms of practice, as well as patients and physicians from racial minorities: a medical group affiliated with an academic medical center in the Southwest, a private group practice in a Midwest suburb, and private solo physicians in an inner-city in the Midwest that belonged to an Independent Practice Association (IPA). The primary investigator at each site was responsible for recruiting physicians using letters and personal contacts. As part of the informed consent, physicians were told that the purpose of the study was to test a doctor-elderly patient transactions coding system and to examine the relationship between physician communication and patient outcomes. They were also informed that the videotapes would be used in the future for teaching and research. More details of the recruitment are available elsewhere (Tai-Seale, Bramson et al. 2005).

Study Population

The recruitment effort resulted in a sample of 37 physicians. The study plan was to videotape each physician with ten elderly patients who also consented to be videotaped. …