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Obesity management in general practice: does current practice match guideline recommendations?

Lyle R Turner, Mark F Harris and Danielle Mazza
Med J Aust 2015; 202 (7): 370-372. || doi: 10.5694/mja14.00998

Summary

Objective: To assess the documentation of measures recommended in the National Health and Medical Research Council clinical practice guidelines for managing overweight and obesity in adults, adolescents and children in Australia.

Design, setting and participants: Retrospective analysis of routine general practice data from 270 426 adult patients. Data were extracted from the Melbourne East Monash General Practice Database, collected from general practice clinics located in the inner-eastern Melbourne region between 1 July 2011 and 31 December 2013.

Main outcome measures: Documentation of quantitative measures of obesity identified in the national guidelines — specifically, body mass index (BMI) and waist circumference.

Results: 22.2% and 4.3% of patients had a BMI and waist circumference, respectively, recorded in their computerised medical records. There were variations in BMI documentation across age and sex, with those aged over 75 years (odds ratio [OR], 1.60; 95% CI, 1.48–1.72) more likely, and women (OR, 0.86; 95% CI, 0.78–0.94) less likely to have a documented BMI. Patients with diabetes (OR, 1.85; 95% CI, 1.70–1.99) or who were prescribed diabetes-related medication (OR, 1.24; 95% CI, 1.12–1.35), those with hypertension (OR, 1.18; 95% CI, 1.11–1.24) or hyperlipidaemia (OR, 1.26; 95% CI, 1.20–1.33) were more likely to have a documented BMI.

Conclusions: Recording of measures of obesity in general practice is currently not consistent with guideline recommendations. Strategies to support general practitioners may improve their documentation of measures of obesity.

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  • Lyle R Turner1
  • Mark F Harris2
  • Danielle Mazza1

  • 1 Monash University, Melbourne, VIC.
  • 2 University of New South Wales, Sydney, NSW.

Correspondence: danielle.mazza@monash.edu

Acknowledgements: 

We thank Adam McLeod and Christopher Pearce from Inner East Melbourne Medicare Local for their comments during the drafting of our manuscript. This work was supported by the Faculty of Medicine, Nursing and Health Sciences, Monash University, and Inner East Melbourne Medicare Local. Mark Harris is supported by an NHMRC Senior Principal Research Fellowship.

Competing interests:

No relevant disclosures.

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access_time 11:30, 13 May 2015
Caitlin Raschke

The suggestion that abdominal circumference as well as BMI be used is based on only level C evidence: hardly a convincing part of the guideline, which as a whole is in no small part based on consensus rather than research. We need evidence that measuring these makes a difference to management. My equally useful evidence (decades of experience) is that it's often counterproductive for overweight patients.

Competing Interests: No relevant disclosures

Dr Caitlin Raschke
Medowie Medical Centre, NSW

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