Obesity and the primary care physician

Accessibility to the office is critical for the obese patient. Facility limitations include difficult access from the parking lot or stairs, narrow doors and hallways, and cramped restrooms. These are the same problems that face other patients with disabilities, and are covered under the regulations of the Americans with Disabilities Act of 1990. One of the first concerns obese patients have upon entering the waiting room is where they can safely sit. Office chairs of standard width and side arm rests will not comfortably accommodate moderately to severely obese patients. Ideal chairs have no arms so that patients do not have to squeeze themselves Table 1 Office-Based Obesity Care The physical environment Accessibility and comfort: stairs, doorways, hallways, restrooms, waiting room chairs and space, reading materials and other educational materials Equipment Large adult and thigh blood pressure cuffs, large gowns, step stools, weight and height scales, tape measure Materials Educational and behavior promoting handouts on diet, exercise, medications, surgery, BMI, obesity-associated diseases Tools Previsit questionnaires, BMI stamps, food and activity diaries, pedometers Protocols Patient care treatment protocols for return visit schedule, medications, referrals to dietitians and psychologists Staffing. Team approach to include office nurse, physician assistant, nurse practitioner, health advocate into predefined “normal” dimensions. Although often thought insignificant, hanging artwork and magazines in the waiting and examination rooms can convey misinterpreted messages to patients. Magazines, newspapers, television, movies, and billboards constantly remind overweight individuals of society’s beauty ideals. Magazines, newsletters, and artwork can be chosen that don’t contribute to these unattainable images.