Addressing Excess Weight in a Busy Women's Clinic

The number of adults with obesity has been rising at an alarming rate, and clinicians are challenged to increase efforts to address this condition. Over 1.6 billion adults in the world are overweight. This causes secondary conditions that ultimately lead to severe morbidity and increased mortality. There are a multitude of conditions that can affect women who are overweight and obese, especially during pregnancy for the woman and her unborn child. Excess weight places a financial strain on the healthcare system as it requires increased money spent on medical equipment such as larger chairs or larger blood pressure cuffs. Excess weight causes an increase in the number of visits to clinicians with increased test utilization due to the comorbid conditions that are associated with excess weight and obesity. Nationwide, a staggering one-third of adults are obese and although rates are lower in Utah, obesity still affects far too many adults. Given the rate at which adults in the United States are gaining weight, actions to reduce weight must be discussed with patients at every opportunity. This is particularly true because a large portion of women may underestimate their weight and body mass index, as well as the implications of what can happen to their health when they have excess weight. The U.S. Preventative Services Task Force has challenged all clinicians to screen every adult for excess weight and refer those who have been diagnosed with obesity out for intensive weight loss therapy. Based on how quickly adults in the United States are gaining weight, it is clear that a diagnosis of excess weight is not enough to create a solution. The purpose of this project was to evaluate the frequency that women's health providers address overweight and obese states in reproductive-age women. Fifty charts were chosen to review to determine how often weight was being addressed at annual exams. This project aimed to educate clinicians in a local women's clinic on the recommended guidelines and provide a list of resources for the clinicians to use when counseling patients. To ensure that the chart review was unbiased a tool called the Five A's (Ask, Advise, Assess, Assist, and Arrange) was used to determine which charts met criteria for weight loss conversations. The chart review indicated that the clinicians were great at asking about current weight, diet, and physical activity, and at advising patients on diet and physical activity to lose weight. However, more resources are needed to assist the clinicians in assessing readiness to change, assisting in setting goals, and arranging for follow up. The resources provided after the chart review was a list of steps a patient can take that will assist the patient in her goal to lose weight. They have been added into the clinic's electronic medical record software so that clinician charting is streamlined regarding documentation of weight loss discussions. These resources, which are methods to begin making lifestyle choices to lose weight, were researched using evidence-based information and were modified for accuracy by the content expert. The results and the resource list have been presented to the clinicians at their monthly clinic meeting, and changes to the resource list were made with the clinicians' feedback. The obesity epidemic is one of the largest challenges of healthcare and it is imperative that all clinicians address this issue to decrease the prevalence of obesity and decrease the morbidity and mortality associated with excess weight. By providing clinicians with the appropriate tools they will be better prepared to tackle the obesity epidemic