Physician Health Counseling for Older Adults with Obesity in the United States, 2015-2019: An Analysis of Repeated Cross-Sectional Data

Abstract

Objectives

Obesity affects one-third of American adults aged ≥65 years. Despite the increasing uptake of prescription weight loss medications, physician provision of diet and exercise weight loss counseling and referrals benefits patients and improves health outcomes. To increase awareness about possible underuse of physician weight loss counseling and referrals, we used nationally representative data to examine their rates in older adults with obesity.

Design

Retrospective cross-sectional analysis of publicly available data from National Ambulatory Medical Care Survey from January 1, 2015, through December 31, 2019.

Setting and Participants

Adults aged ≥65 years with obesity, as defined by a body mass index (BMI) of 30 or higher.

Methods

Primary outcomes were prevalence of obesity diagnosis and type of physician behavioral counseling provided to older patients. Data were analyzed using Poisson regression.

Results

Between 2015 and 2019, American adults aged ≥65 years made approximately 301 million physician office visits annually, and height and weight data were available for BMI estimation in 65.2% of visits. Among these visits, 35.3% were for patients with BMI ≥30 and 29.4% had a diagnosis of obesity during the visit. The prevalence of health counseling for obesity was low and ranged from 7.9% for weight reduction counseling to 18.7% for diet counseling. In adjusted analyses, patients aged ≥75 years were less likely to receive weight reduction counseling than patients aged 65-74 years. Women were less likely to receive weight reduction counseling than men. Having a diagnosis of obesity and seeing a primary care physician were both associated with increased likelihood of receiving weight reduction, diet, and exercise counseling. Antiobesity medication was prescribed in <1% of visits.

Conclusions and Implications

Despite a high prevalence of obesity among older adults in the United States, physicians underdiagnose these patients and often do not provide them with obesity-related health counseling. Substantial opportunities exist to improve the care of older adults with obesity who face an increased risk of obesity-related chronic disease and physical disability.