Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management


The Norman J. Arnold School of Public Health

First Advisor

Ramzi Salloum


Background: The United States Preventive Services Task Force (USPSTF) recommends three types of health education counseling for use in primary care practices for adult, obese patients. While these recommendations are well known, a low percentage of physicians provide this counseling to their patients on a consistent basis. There are inconsistencies in past studies in regards to what aspects of the health encounter influence the likelihood of receiving health education counseling during a primary care visit. The objective of this study was to (1) investigate the patterns of these three types of counseling occurring within primary care practices and to (2) investigate the influence of patient and provider characteristics on counseling within primary care practices.

Methods: We analyzed aggregated data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). The three types of health education counseling were the dependent variables, while patient and provider characteristics were the independent variables.

Results: Of the 11,041 obese patients seen, 70.3% had no type of counseling provided while only 7.6% had all three types of recommended counseling provided. The highest combination of counseling provided was diet/nutrition and exercise counseling, while the lowest combination was exercise and weight reduction counseling. Additionally, the odds of receiving all 3 types of health education counseling are increased for patients when their obesity check box is checked, being seen for a preventive care visit, having Class III obesity, and seen within an urban practice.

Conclusion: Although physicians see a vast amount of adult obese patients within primary care practice, health education counseling practices by primary care physicians remains less than optimal. Therefore, there is a drastic need to improve this type of health education counseling by primary care physicians in order to address the current obesity epidemic in the U.S.