Background

Despite increasing trends of obesity and cardiometabolic disease in the United States, variations in weight-related counseling persist among primary care providers (PCPs). Thus, there is a need to identify correlates of weight-related physician-initiated counseling.

Methods

Data from 2016 National Ambulatory Medical Care Surveys (NAMCS) were utilized to identify correlates of weight-related counseling in adults (>17 years). Four outcome variables-diabetes, diet and nutrition, exercise, and weight reduction were regressed on patient characteristics (e.g. age, insurance, and overall comorbidity risk) and provider characteristics (e.g. urban practice, internal medicine or general/family practitioner). Separate multivariate logistic regression models, with patient visit survey weights, were used for each outcome.

Results

Of the 2,435 patients included, 4.44% received counseling in diabetes, 19.84% in diet and nutrition, 15.48% in exercise, and 7.93% in weight reduction. Positive correlates (p-value<0.001) were found for patients with some overall comorbidity risk, compared to patients with no comorbidity risk, for counseling outcomes of diet and nutrition [AOR 5.108, 95% CI 2.72-9.57], exercise [AOR 4.760, 95% CI 2.43-9.29], and weight reduction [AOR 17.651, 95% CI 7.71-40.37]. Alternatively, compared to patients with private insurance, patients with public (Medicare/Medicaid) or no insurance had significantly lower odds of receiving weight reduction counseling (p-value<0.05),[AOR 0.630, 95% CI 0.40-0.98] and [AOR 0.349, 95% CI 0.13-0.92] respectively. Positive correlates for provider characteristics of diet and nutrition counseling included urban practices [1.455, 95% CI 1.02-2.06], compared to rural, and new patients [AOR 2.006, 95% CI 1.10-3.63], compared to prior patients.

Conclusions

These results suggest patient characteristics of insurance type and comorbidity risk are correlates of weight-related counseling; provider characteristics of location and initial visit may also be correlates.