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


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.

Please login with your free MJA account to view this article in full

  • Lyle R Turner1
  • Mark F Harris2
  • Danielle Mazza1

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



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.

  • 1. Nolan C, Deehan A, Wylie A, Jones R. Practice nurses and obesity: professional and practice-based factors affecting role adequacy and role legitimacy. Prim Health Care Res Dev 2012; 13: 353-363.
  • 2. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: NHMRC, 2013. (accessed Oct 2014).
  • 3. Mazza D, Harris MF. Improving implementation of evidence-based prevention in primary care. Med J Aust 2010; 193: 101-102. <MJA full text>
  • 4. Australian Bureau of Statistics. An introduction to Socio-Economic Indexes for Areas (SEIFA), 2006. Canberra: ABS, 2008. (ABS Cat. No. 2039.0.) (accessed Oct 2014).
  • 5. Rose SA, Turchin A, Grant RW, Meigs JB. Documentation of body mass index and control of associated risk factors in a large primary care network. BMC Health Serv Res 2009; 9: 236.
  • 6. Baer HJ, Karson AS, Soukup JR, et al. Documentation and diagnosis of overweight and obesity in electronic health records of adult primary care patients. JAMA Intern Med 2013; 173: 1648-1652.
  • 7. Smith N, Coleman KJ, Lawrence JM, et al. Body weight and height data in electronic medical records of children. Int J Pediatr Obes 2010; 5: 237-242.
  • 8. Otero P, Durán P, Setton D, et al. Mismatch between the prevalence of overweight and obese children and adolescents and recording in electronic health records: a cross-sectional study. Inform Prim Care 2011; 19: 75-82.
  • 9. Rattay KT, Ramakrishnan M, Atkinson A, et al. Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity. Pediatrics 2009; 123 Suppl 2: S100-S107.
  • 10. Turner KM, Shield JP, Salisbury C. Practitioners' views on managing childhood obesity in primary care: a qualitative study. Br J Gen Pract 2009; 59: 856-862.
  • 11. Williams G, de Zulueta P, Iliffe S. Childhood obesity. Br J Gen Pract 2006; 56: 971.
  • 12. Andersen MK, Christensen B, Søndergaard J. Care for overweight children attending the 5-year preventive child health examination in general practice. Fam Pract 2013; 30: 48-55.
  • 13. McMeniman E, Moore R, Yelland M, McClure R. Childhood obesity: how do Australian general practitioners feel about managing this growing health problem? Aust J Prim Health 2011; 17: 60-65.
  • 14. Saviñon C, Taylor JS, Canty-Mitchell J, Blood-Siegfried J. Childhood obesity: can electronic medical records customized with clinical practice guidelines improve screening and diagnosis? J Am Acad Nurse Pract 2012; 24: 463-471.
  • 15. Muo IM, Sacajiu G, Kunins H, Deluca J. Effect of the availability of weight and height data on the frequency of primary care physicians' documented BMI, diagnoses and management of overweight and obesity. Qual Prim Care 2013; 21: 221-228.
  • 16. Proudfoot J, Infante F, Holton C, et al. Organisational capacity and chronic disease care: an Australian general practice perspective. Aust Fam Physician 2007; 36: 286-288.
  • 17. Pearce C, Shearer M, Gardner K, Kelly J. A division's worth of data. Aust Fam Physician 2011; 40: 167-170.
  • 18. Gardner K, Mazza D. Quality in general practice – definitions and frameworks. Aust Fam Physician 2012; 41: 151-154.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

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

Responses are now closed for this article.