Skip to main content
main-content
Top

04-29-2017 | Obesity | Article

Impact of Physician Training on Diagnosis and Counseling of Overweight and Obese Asian Patients

Journal: Journal of Racial and Ethnic Health Disparities

Authors: Deepa A. Vasudevan, Thomas F. Northrup, Sreedhar Mandayam, Oluwatosin O. Bamidele, Angela L. Stotts

Publisher: Springer International Publishing

share
SHARE

Abstract

Background and Objectives

Obesity is widely underdiagnosed among Asians, due in part to a lack of physician awareness of the modified diagnostic criteria for Asians. This study investigated the effect of a physician training on accurately diagnosing obesity among and providing weight counseling to overweight and obese Asian patients.

Methods

Physicians (N = 16) from five primary care practices received 1 h of face-to-face training and other reminder resources (e.g., wallet card) describing the guidelines for the diagnosis of overweight/obesity among Asians, as well as weight counseling instruction. Chart reviews of overweight/obese Asian patients were conducted for the 12 months before the training (n = 198) and 3 months following the training (n = 163). Physician race (Asian/non-Asian) and clinic setting (private/academic) were included as outcome moderators.

Results

Patients were predominantly male (63.1 %), with a mean age of 46.0 years (SD = 14.9) and an average BMI of 28.2 (SD = 3.8). Across all physicians, 26.8 and 45.1 % of patients were accurately diagnosed as overweight or obese before and after the training, respectively (p < 0.05). The odds of a physician correctly diagnosing Asian patients as overweight or obese were 102 % higher at post-training after accounting for nesting of patients within physicians. Similarly, weight counseling was higher (65.0 %) following training compared to pre-training levels (43.9 %) but failed to reach significance (p = 0.06).

Conclusions

Accurate identification and counseling of overweight/obese Asian patients can be improved by education and training. Universal adoption of race-specific guidelines will ensure more successful weight management and reduced morbidity in a rapidly growing Asian population.
Literature
1.
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822–w31. CrossRef
2.
Iciar Martín-Timón, Cristina Sevillano-Collantes, Amparo Segura-Galindo, and Francisco Javier del Cañizo-Gómez. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes 2014;5(4): 444–470 http://​www.​ncbi.​nlm.​nih.​gov/​pmc/​articles/​PMC4127581/​
3.
Buse JB, Ginsberg HN, Bakris GI, Clark NG, Costa F, Fonseca V, Gerstein HC, Grundy S, Nesto RW, Pignone MP, Plutzky J, Porte D, Redberg R, Stitzel KF, Stone NJ. Primary prevention of cardiovascular diseases in people with diabetes mellitus. Diabetes Care, 2007;30:162–172 http://​care.​diabetesjournals​.​org/​content/​30/​1/​162.​full.​pdf+html
4.
Center for Disease Control and Prevention. Heart disease facts. Atlanta: CDC; 2015 http://​www.​cdc.​gov/​heartdisease/​facts.​htm
5.
Liang Chen, Jian-Hao Pei, Jian Kuang, Hong-Mei Chen, Zhong Chen, Zhong-Wen Li, Hua-Zhang Yang. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism 2015. 64(2):338–347 http://​www.​sciencedirect.​com/​science/​article/​pii/​S002604951400312​6
6.
Hoeffel EM, Rastogi S, Kim MO, Hasan S, Census USBot. The Asian population: 2010. US Department of Commerce, economics and statistics administration, US Census Bureau; 2012.
7.
Health UDo, Services H, Control CfD, Prevention. Diabetes report card 2012. Atlanta, GA 2012.
8.
Schiller J, Lucas J, Peregoy J. Summary health statistics for US. Adults: National Health Interview Survey. 2011. Hyattsville: CDC.
9.
WHO EC. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157. CrossRef
10.
Vasudevan D, Stotts AL, Mandayam S, Omegie LA. Comparison of BMI and anthropometric measures among South Asian Indians using standard and modified criteria. Public Health Nutr. 2011;14(05):809–16. CrossRefPubMed
11.
Vasudevan D, Stotts A, Anabor OL, Mandayam S. Primary care physician’s knowledge of ethnicity-specific guidelines for obesity diagnosis and readiness for obesity intervention among South Asian Indians. J Immigr Minor Health. 2012;14(5):759–66. CrossRefPubMed
12.
Allison PD. Logistic regression using SAS: theory and application. Cary: SAS Institute; 2012.
13.
Bleich SN, Bennett WL, Gudzune KA, Cooper LA. National survey of US primary care physicians’ perspectives about causes of obesity and solutions to improve care. BMJ open. 2012;2(6):e001871. CrossRefPubMedPubMedCentral
14.
Lytle LA. Examining the etiology of childhood obesity: the IDEA study. Am J Community Psychol. 2009;44(3–4):338–49.
15.
Seaton Banerjee E, Gambler A, Fogleman C. Adding obesity to the problem list increases the rate of providers addressing obesity. Fam Med. 2013;45(9):629–33.
16.
Jay M, Schlair S, Caldwell R, Kalet A, Sherman S, Gillespie C. From the patient’s perspective: the impact of training on resident physician’s obesity counseling. J Gen InternMed. 2010;25(5):415–22.
17.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.
18.
Kraschnewski JL, Sciamanna CN, Stuckey HL, Chuang CH, Lehman EB, Hwang KO, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care. 2013;51(2):186–92.
19.
Kristeller JL, Hoerr RA. Physician attitudes toward managing obesity: differences among six specialty groups. Prev Med. 1997;26(4):542–9.