Provider practice habits and barriers to care in obesity management in a large multicenter health system.
Simon R, and Lahiri SW. Provider practice habits and barriers to care in obesity management in a large multicenter health system. Endocr Rev 2018; 39(2)
Obesity prevalence in adults demonstrated an increase from 31% in 1999-2000 to 38% in 2013-2014. Despite this epidemic, descriptive studies on provider attitudes and practices show infrequent use of pharmacotherapy and referral to bariatric surgery. This study's objective was to evaluate provider practice habits and barriers in obesity management in a multicenter academic health system (Henry Ford Health System) with extensive resources including comprehensive weight loss management programs and a bariatric surgery program. A 26- question survey was sent to 430 providers in primary care and endocrinology. 111 (26%) of the 430 surveys were completed and used for analysis. Most were in primary care (50% Internal Medicine, 25% Family Medicine, 16% Women's Health) while 9% were in Endocrinology. 54% were attending physicians while the rest were residents (40%), fellows (4%), and mid-level providers (2%). 50% of respondents advised weight loss in >50% of clinic visits when BMI was >30 kg/m2. Limited time (82%) was the most common reason for not addressing obesity. Other reasons included insufficient knowledge, discomfort broaching the subject, and the perception that patient behavior would not change. Providers had a high rate of counseling on diet and exercise (>92%) and referring to formal weight loss programs (73%). However, only 29% reported discussing obesity medications. Reported barriers included limited experience (57%), concern for adverse reactions (26%), cost/insurance concerns (19%), lack of awareness of medication (15%), and lack of perceived efficacy (14%). Bariatric surgery referrals were also low (44%) due to concern of high surgical risk (57%), concern of adverse events (32%), limited experience (27%), lack of awareness of long term outcomes (16%), lack of knowledge (15%), not knowing bariatric surgeons (12%), and discomfort with discussing topic (10%). Slightly higher frequencies of formal weight loss recommendations were reported with BMI >40 than 30-39 kg/m2. Comparing practice habits among specialties revealed low frequency of any formal obesity treatment recommendations by Women's Health respondents perhaps due to high numbers of obstetric patients. Analysis by level of training showed that attending physicians and fellows were more likely to advise weight loss at earlier BMI, offer medications, and refer to bariatric surgery than residents. Our study reveals provider reluctance and lack of confidence in managing obesity with pharmacotherapy and bariatric surgery when indicated, especially in the earlier stages of obesity. Barriers identified include lack of time, knowledge, and experience along with concerns about adverse effects and risk. Limitations include small sample size, low response rate, and inability to make causal inferences from these results. Despite limitations, this data can guide future efforts to.