Accuracy and congruence of patient and physician weight-related discussions: From project CHAT (Communicating health: Analyzing talk)

Objective: primary care providers should counsel overweight patients to lose weight. rates of self-reported,weight-related counseling vary,perhaps because of self-report bias. we assessed the accuracy and congruence of weight-related discussions among patients and physicians during audio-recorded encounters. methods: we audio-recorded encounters between physicians (n = 40) and their overweight/obese patients (n = 461) at 5 community-based practices. we coded weight-related content and surveyed patients and physicians immediately after the visit. generalized linear mixed models assessed factors associated with accuracy. results: overall,accuracy was moderate: patient (67%),physician (70%),and congruence (62%). when encounters containing weight-related content were analyzed,patients (98%) and physicians (97%) were highly accurate and congruent (95%),but when weight was not discussed,patients and physicians were more inaccurate and incongruent (patients,36%; physicians,44%; 28% congruence). physicians who were less comfortable discussing weight were more likely to misreport that weight was discussed (odds ratio,4.5; 95% confidence interval,1.88 -10.75). white physicians with african american patients were more likely to report accurately no discussion about weight than white physicians with white patients (odds ratio,0.30; 95% confidence interval,0.13- 0.69). conclusion: physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed but not when recordings indicated no weight discussions. physicians' overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions.