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.