Cardiovascular Risk Factors and Provision of Lifestyle Counseling for Diabetes or Prediabetes With Comorbid Obesity: Analysis of Office-Based Physician Visits Made by Patients 20 Years of Age or Older

Obesity, defined as a BMI ≥30 kg/m2, is one of the most common and costly preventable causes of death in the United States (1–3). Increased prevalence of obesity, which affects an estimated 36.5% of U.S. adults (1), has been linked to a growing risk of morbidity from several medical conditions, including diabetes and heart disease (4). In parallel with increases in obesity rates (4), the age-adjusted percentage of adults with diagnosed diabetes increased from 3.6% in 1990 to 8.7% in 2010 (5), and an estimated 9.3% of U.S. adults had diagnosed diabetes in 2015 (6). Prediabetes, another consequence of obesity, affects ∼34% of U.S. adults, placing them at increased risk of developing diabetes and cardiovascular complications (5,7). Of those with prediabetes, only about 12% report having been told by a health care professional that they had the condition (5). A previous analysis of office-based physician visits made by U.S. patients with diabetes in 2005, conducted by Neumiller et al. with data reported in the National Ambulatory Medical Care Survey (NAMCS), found that comorbid obesity increased the likelihood of presenting with concomitant disease states such as heart failure (6.1% for obesity/diabetes visits vs. 4.0% for all diabetes visits), depression (21.2 vs. 10.8%), hyperlipidemia (62.2 vs. 46.3%), and hypertension (71.4 vs. 64.1%) (8). Obesity was also associated with increases in the ordering or provision of lifestyle counseling (e.g., diet/nutrition counseling in 58.8% of obesity/diabetes visits vs. 36.6% of all diabetes visits) (8). Since the time of the study by Neumiller et al., attention to obesity-related health risks has increased, with a focus on the potential for early screening and intervention to prevent disease progression, such as from prediabetes to diabetes or from diabetes to cardiovascular disease (9,10). These trends make it important …