Weight management practices of health center providers in the United States

ABSTRACT

Background

We examined weight management counseling practices of Health Resources and Services Administration-funded health center (HC) providers for patients with overweight (POW) and obesity (POB) status, focusing on weight-related conditions, risk factors, and health care utilization.

Method

We used a nationally representative cross-sectional survey of HC patients and multilevel generalized structural equation logistic regression models to assess the association of provider counseling practices for POW and POB and by three obesity classes. Dependent variables included being told by the HC provider that weight was a problem, receiving a diet or exercise recommendation, referral to a nutritionist, or receiving weight loss prescriptions. Independent variables included weight-related conditions such as diabetes and hypertension, risk factors such as smoking, and health service utilization such as five or more primary care visits.

Results

All POB classes had higher odds of receiving all five counseling interventions than POW. Patients with diabetes and high cholesterol had higher odds of diet recommendations (OR = 1.8) and nutritionist referrals (OR = 2.3), while patients with cardiovascular disease had higher odds of nutritionist referral (OR = 2.0) and receiving weight loss prescriptions (OR = 2.6). Respondents with POB class III and diabetes had higher odds of receiving exercise recommendations (OR = 3.4), while POB class 1 and had hypertension had lower odds of nutritionist referral (OR = 0.3).

Conclusions

Variations in HC primary care providers’ weight management counseling practices between POW and POB present missed opportunities for consistent practice and early intervention. Assessing providers’ counseling practices for patients with comorbid conditions is essential to the successful management of the obesity crisis.

KEYWORDS:

• Primary health care
• overweight
• obesity
• weight management
• community health centers
• provider practices
• guidelines

Disclosure statement

HH and AS are employees of the U.S. Government, U.S. Department of Health and Human Services, which funded this study.

Ethics Approval

The University of California Los Angeles institutional review board determined this study exempt due to analysis of secondary data (study decision letter #20-001114, decisioned June 11, 2020).

Additional information

Funding

This research was funded by the Health Resources and Services Administration (HRSA) under HRSA contract number HHSH250201300023I. The views expressed in this publication are solely the opinions of the authors and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services or HRSA, nor does mention of the department or agency names imply endorsement by the U.S. Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Notes on contributors

Nadereh Pourat

Nadereh Pourat is a professor in the Department of Health Policy and Management, UCLA Fielding School of Public Health, and associate director of the UCLA Center for Health Policy Research.

Connie Lu

Connie Lu is a project manager and research analyst at the UCLA Center for Health Policy Research.

Xiao Chen

Xiao Chen is a senior statistician at the UCLA Center for Health Policy Research.

Weihao Zhou

Weihao Zhou is a statistician at the UCLA Center for Health Policy Research.

Hank Hoang

Hank Hoang is Deputy Director of Data and Evaluation, Office of Quality Improvement, Bureau of Primary Health Care, HRSA

Alek Sripipatana

Alek Sripipatana is Director of Data and Evaluation, Office of Quality Improvement, Bureau of Primary Health Care, HRSA.