Physician Body Mass Index and Bias Toward Obesity Documentation Patterns

Many healthcare professionals consider obese individuals to be unmotivated and to lack the willpower to follow through with weight-loss plans. This attitude may result in less effort put into diagnosing, documenting, and treating obesity. Our aim was to assess documentation patterns of obesity and hypertension overall, by primary care specialty, and in relation to provider body mass index (BMI).

Twenty-two physicians from one outpatient community practice were included: 10 internal medicine and 12 family practice practitioners. We conducted a retrospective review of medical records from a 1-year period to determine provider documentation of obesity and hypertension.

A total of 3,275 obese patients were under the care of 6 physicians with normal BMI, yielding an obesity documentation rate of 23.2%. The 10 overweight physicians had 6,218 obese patients and a documentation rate of 33.5%. The 6 obese physicians had 4,014 patients with obesity and a documentation rate of 21.7%. Obesity documentation rates differed between nonobese physicians (BMI 20-29.9 kg/m²) (30.0%) and obese (BMI ≥30 kg/m²) physicians (21.7%) (P<0.001). We found no difference (P=0.132) between documentation rates of normal-weight BMI physicians and obese physicians. The overall documentation rate of obesity (27.5%) was significantly different than the overall documentation rate of hypertension (83.3%) (P<0.001).

In our study, nonobese physicians were more likely to document obesity, and documentation of obesity lagged significantly in comparison to hypertension. Addressing weight loss in obese patients starts at the provider level. Steps include documenting obesity on the problem list and providing weight-loss advice during each patient encounter.