Physician Counseling of Overweight Patients About Preventive Health Behaviors

Background: Numerous studies show that many primary care physicians (PCPs) do not discuss preventive health behaviors related to diet and exercise with their overweight patients. Purpose: To investigate whether certain counseling approaches by PCPs in their clinical encounters with patients are associated with improvements in care and resource utilization. Methods: A total of 2205 patients in a large HMO were surveyed, during November and December 2010, about their health behaviors and perceptions of their interactions with their PCPs. Survey responses from each patient were matched with 48 months of patient-specific medical claims data, from October 2008 through September 2012, capturing the frequency and monetary costs of health care utilization. A series of regression analyses, completed in June 2013, focused on four dependent variables: patients' intentions to improve diet and activity, patients' satisfaction with their physicians, visits to healthcare providers, and health plan spending on treatment. Results: For each finding, the degree of physician-patient discussion of preventive health behaviors was strengthened when (1) physicians expressed confidence in patients' ability to improve diet and exercise and (2) patients had confidence that their physician could facilitate improvement of these behaviors. Conclusions: The associations between physician counseling and subsequent key improvements for overweight patients are strengthened by the physician's confidence in the patient's ability to engage in preventive health behaviors and the patient's confidence in the physician's ability to help in implementing these behaviors. Cultivating such mutual confidence is instrumental in optimizing physicians' influence on overweight patients' health behaviors.