Provider Advice and Patient Perceptions on Weight Across Five Health Systems


      To improve the management of overweight and obesity in the primary care setting, an analysis of patient perceptions of weight status and predictors of weight loss attempts for those with overweight and obesity is needed.


      Primary care patients (n=949) across 5 health systems in the Mid-Atlantic region of the U.S. were surveyed in 2015; data analysis was performed in 2018. Survey data was combined with data via the electronic health record to understand patients’ perceptions of weight, factors associated with weight loss efforts, and provider counseling practices.


      Most participants with overweight or obesity perceived themselves as weighing too much and reported trying to lose weight. Furthermore, most participants with obesity reported receiving advice to lose weight by a provider in the past 12 months. However, less than half of patients with overweight reported receiving advice to lose weight, maintain weight, or develop healthy eating and physical activity patterns from a health professional in the past 12 months. Among participants with overweight and obesity, multivariable logistic regression analysis demonstrated that the perception of being overweight and receiving healthcare advice to lose weight had the highest odds of reporting attempted weight loss (OR=5.5, 95% CI=2.7, 11.2 and OR=3.9, 95% CI=1.9, 7.9, respectively).


      The findings emphasize the importance of provider attention to weight management counseling and identifies patients with overweight as needing increased attention by providers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hales CM
        • Fryar CD
        • Carroll MD
        • Freedman DS
        • Ogden CL
        Trends in obesity and severe obesity prevalence in U.S. youth and adults by sex and age, 2007-2008 to 2015-2016.
        JAMA. 2018; 319: 1723-1725
        • Heron M
        Deaths: leading causes for 2017.
        Natl Vital Stat Rep. 2019; 68 ( Accessed February 1, 2020): 1-77
        • Bhaskaran K
        • Dos-Santos-Silva I
        • Leon DA
        • Douglas IJ
        • Smeeth L
        Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK.
        Lancet Diabetes Endocrinol. 2018; 6: 944-953
      1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. Circulation. 2014;129(25 suppl 2):S102–S138.

        • Torti J
        • Luig T
        • Borowitz M
        • Johnson JA
        • Sharma AM
        • Campbell-Scherer DL
        The 5As team patient study: patient perspectives on the role of primary care in obesity management.
        BMC Fam Pract. 2017; 18: 19
        • Bennett WL
        • Wang NY
        • Gudzune KA
        • et al.
        Satisfaction with primary care provider involvement is associated with greater weight loss: results from the practice-based POWER trial.
        Patient Educ Couns. 2015; 98: 1099-1105
        • Sciamanna CN
        • Tate DF
        • Lang W
        • Wing RR
        Who reports receiving advice to lose weight? Results from a multistate survey.
        Arch Intern Med. 2000; 160: 2334-2339
        • Yaemsiri S
        • Slining MM
        • Agarwal SK
        Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study.
        Int J Obes (Lond). 2011; 35: 1063-1070
        • Post RE
        • Mainous AG
        • Gregorie SH
        • Knoll ME
        • Diaz VA
        • Saxena SK
        The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States.
        Arch Intern Med. 2011; 171: 316-321
        • Burke MA
        • Heiland FW
        • Nadler CM
        From “overweight” to “about right”: evidence of a generational shift in body weight norms.
        Obesity (Silver Spring). 2010; 18: 1226-1234
        • Galuska DA
        • Will JC
        • Serdula MK
        • Ford ES
        Are health care professionals advising obese patients to lose weight.
        JAMA. 1999; 282: 1576-1578
        • Kraschnewski JL
        • Sciamanna CN
        • Pollak KI
        • Stuckey HL
        • Sherwood NE
        The epidemiology of weight counseling for adults in the United States: a case of positive deviance.
        Int J Obes (Lond). 2013; 37: 751-753
        • Kraschnewski JL
        • Sciamanna CN
        • Stuckey HL
        • et al.
        A silent response to the obesity epidemic: decline in U.S. physician weight counseling.
        Med Care. 2013; 51: 186-192
        • McAlpine DD
        • Wilson AR
        Trends in obesity-related counseling in primary care: 1995-2004.
        Med Care. 2007; 45: 322-329
        • Ahmed NU
        • Delgado M
        • Saxena A
        Trends and disparities in the prevalence of physicians’ counseling on diet and nutrition among the U.S. adult population, 2000-2011.
        Prev Med. 2016; 89: 70-75
        • Jackson JE
        • Doescher MP
        • Saver BG
        • Hart LG
        Trends in professional advice to lose weight among obese adults, 1994 to 2000.
        J Gen Intern Med. 2005; 20: 814-818
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
      2. Youth Risk Behavior Surveillance System. Centers for Disease Control and Prevention. Updated June 14, 2018. Accessed April 16, 2019.

        • So R
        • Shinohara K
        • Aoki T
        • Tsujimoto Y
        • Suganuma AM
        • Furukawa TA
        Effect of recruitment methods on response rate in a web-based study for primary care physicians: factorial randomized controlled trial.
        J Med Internet Res. 2018; 20: e28
        • Miller HN
        • Gleason KT
        • Juraschek SP
        • et al.
        Electronic medical record–based cohort selection and direct-to-patient, targeted recruitment: early efficacy and lessons learned.
        J Am Med Inform Assoc. 2019; 26: 1209-1217
        • Pfaff E
        • Lee A
        • Bradford R
        • et al.
        Recruiting for a pragmatic trial using the electronic health record and patient portal: successes and lessons learned.
        J Am Med Inform Assoc. 2019; 26: 44-49
        • Martin CB
        • Herrick KA
        • Sarafrazi N
        • Ogden CL
        Attempts to lose weight among adults in the United States, 2013–2016.
        National Center for Health Statistics, NCHS Data Brief, no 313, Hyattsville, MD2018 ( Accessed February 1, 2020)
        • Lawrence EM
        Why do college graduates behave more healthfully than those who are less educated.
        J Health Soc Behav. 2017; 58: 291-306
        • Bombak A
        Obesity, health at every size, and public health policy.
        Am J Public Health. 2014; 104: e60-e67
        • Friedman CP
        • Wong AK
        • Blumenthal D
        Achieving a nationwide learning health system.
        Sci Transl Med. 2010; 2 (57cm29.
        • Prochaska JO
        • Velicer WF
        The transtheoretical model of health behavior change.
        Am J Health Promot. 1997; 12: 38-48