Secular trends in the diagnosis and treatment of obesity among US adults in the primary care setting

Obesity (Silver Spring). 2012 Sep;20(9):1909-14. doi: 10.1038/oby.2011.271. Epub 2011 Aug 25.


Excess weight afflicts the majority of the US adult population. Research suggests that the role of primary care physicians in reducing overweight and obesity is essential; moreover, little is known about self-care of obesity. This report assessed the secular trends in the care of overweight and investigated the secular association between obesity with care of overweight in primary care and self-care of overweight. Cross-sectional evaluation of the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the Continuous NHANES (1999-2008) was employed; the total sample comprised 31,039 nonpregnant adults aged 20-90 years. The relationship between diagnosed overweight, and directed weight loss with time and obesity was assessed. Despite the combined secular increase in the prevalence of overweight and obesity (BMI >25.0 kg/m(2)) between 1994 and 2008 (56.1-69.1%), there was no secular change in the odds of being diagnosed overweight by a physician when adjusted for covariates; however, overweight and obese individuals were 40 and 42% less likely to self-diagnose as overweight, and 34 and 41% less likely to self-direct weight loss in 2008 compared to 1994, respectively. Physicians were also significantly less likely to direct weight loss for overweight and obese adults with weight-related comorbidities across time (P < 0.05). Thus, the surveillance of secular trends reveals that the likelihood of physician- and self-care of overweight decreased between 1994 and 2008 and further highlights the deficiencies in the management of excess weight.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Comorbidity
  • Continuity of Patient Care / standards*
  • Continuity of Patient Care / trends
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys / trends
  • Obesity / diagnosis*
  • Obesity / epidemiology
  • Obesity / therapy*
  • Physician-Patient Relations
  • Prevalence
  • Primary Health Care / standards*
  • Primary Health Care / trends
  • Risk Factors
  • Self Care / statistics & numerical data*
  • Self Care / trends
  • Sex Distribution
  • Surveys and Questionnaires
  • Time Factors
  • United States / epidemiology
  • Weight Loss*
  • Young Adult