At the Doctor's

Do Physicians See Obesity?

Physician Office Visits for Obesity 2012If you just look at the data, you might think it’s seldom that physicians see obesity in routine clinical practice. CDC has issued a new report on physician office visits for obesity by adults in the U.S. Given that 38% of adults in the U.S. have obesity and obesity is widely recognized to be the biggest threat to the health of Americans for this century, we should be shocked that office visits for obesity are rare. The numbers added up to only 11 million visits in 2012, representing only 2% of all office visits by adults who were not pregnant or postpartum.

But we are not shocked in the least. Michelle Look, an expert in both family medicine and obesity medicine, explains that this observation matches her experience:

In my experience, primary care physicians hesitate to address the disease of obesity and rarely actually make the diagnosis. This is a significant barrier to PCPs effectively addressing the disease.

This situation is unsurprising because physicians do what they get paid to do and health plans routinely refuse to pay for obesity care. Or the plans pay for it at a rate that ensures that doctors will lose money if they spend time dealing with obesity. Physicians get much better compensation for treating the type 2 diabetes, heart disease, and a host of other conditions that result from untreated obesity.

But equally or more important is the fact that obesity is a difficult subject for both physicians and patients to discuss. The stigma attached to obesity makes discussions risky for physicians and embarrassing for patients.

It’s hard to deal with a problem if you can’t talk about it.

Click here for the CDC report and here to read more from MedPage Today.

At the Doctor’s, painting by Vladimir Makovsky / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


March 18, 2016

4 Responses to “Do Physicians See Obesity?”

  1. March 18, 2016 at 6:05 am, Joe Gitchell said:

    Ted – this is really frustrating as PCPs could play a much larger role–but it is going to take a few big changes to really shift things.

    It has been a long slog with smoking, as you well know, but some progress has been made. But I would submit that smoking is a useful reminder that folks trying to improve health and life outcomes for those with obesity cannot put all of their eggs in the traditional health care system basket.


    • March 18, 2016 at 8:01 am, Ted said:

      Thanks, Joe. You’re right.

  2. March 18, 2016 at 7:23 am, Angela Meadows said:

    “Given that 38% of adults in the U.S. have obesity and obesity is widely recognized to be the biggest threat to the health of Americans for this century, we should be shocked that office visits for obesity are rare.”

    Really, Ted? Really?

    It is less than a week since you wrote this in your comments to the ‘straw man’ post:

    “I’m glad you mentioned all the misguided publications that try to ascertain and then bemoan that not enough people label themselves as having obesity. It strikes me as a spectacularly unhelpful agenda to pursue.

    BMI was developed as a tool for epidemiologists to estimate the prevalence of health risks attributable to excess adiposity and the metabolic dysfunction that results from the accumulation visceral fat. If you want the latest data on the prevalence of obesity, this is a good reference:” [Note, this reference defines obesity as having a BMI > 30]

    “While BMI is useful for epidemiology, it’s not very useful for diagnosing the health status of individuals. If you want to know more about the clinical assessment of obesity, I would suggest reading up on the EOSS.”

    I agree that EOSS is more nuanced, but you continue to say on the one hand that “obesity” is not defined by weight/BMI, while citing statistics that define it as exactly that, and decrying that lack of attention paid to people whose problem appears to be having a high BMI.

    I don’t read your blog to argue with you. Honest! I read it because we agree on a lot of things and I often find your posts interesting and informative. But you simply can’t have it both ways on this issue and expect us to take you at your word when you say that you and others *in the know* understand that ‘obesity’ is more than just BMI.

    • March 18, 2016 at 8:01 am, Ted said:

      Thanks, Angela, for reading and commenting.

      I plan to continue to have my cake and eat it, too.

      For the epidemiologic task of estimating how many people have obesity, BMI is great. CDC statistics are reliable in this regard.

      For understanding the health status of a particular person, it’s lousy. That takes a lot more than BMI.

      I’m pretty sure that I explained this point in the quote that you provided. But I also understand your view that excess adiposity is not a health problem. On that point, we just disagree. And to be clear, excess adipose tissue is defined as adipose tissue that’s harming health. Usually that means it’s visceral adipose tissue.

      Thanks especially, Angela, for illustrating how difficult conversations about obesity are. And thanks for reminding me that you’re not just trying to be argumentative.