ORIGINAL RESEARCH Accuracy and Congruence of Patient and Physician Weight-Related Discussions: From Project CHAT (Communicating Health: Analyzing Talk)

Objective: Primary care providers should counsel overweight patients to lose weight. Rates of self-re-ported, weight-related counseling vary, perhaps because of self-report bias. We assessed the accuracy and congruence of weight-related discussions among patients and physicians during audio-recorded encounters. Methods: We audio-recorded encounters between physicians (n 40) and their overweight/obese patients (n 461) at 5 community-based practices. We coded weight-related content and surveyed pa-tients and physicians immediately after the visit. Generalized linear mixed models assessed factors as-sociated with accuracy. Results: Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters containing weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%), but when weight was not discussed, patients and phy-sicians were more inaccurate and incongruent (patients, 36%; physicians, 44%; 28 % congruence). Physi-cians who were less comfortable discussing weight were more likely to misreport that weight was dis-cussed (odds ratio, 4.5; 95 % confidence interval, 1.88–10.75). White physicians with African American patients were more likely to report accurately no discussion about weight than white physicians with white patients (odds ratio, 0.30; 95 % confidence interval, 0.13–0.69). Conclusion: Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed but not when recordings indicated no weight discussions. Physicians ’ overestimation of weight discussions when weight is not discussed con-stitutes missed opportunities for health interventions. (J Am Board Fam Med 2014;27:70–77.