Referral sources to a weight management program: relation to outcome

Abstract

Objective: To examine the characteristics and outcomes of physician-referred weight management patients relative to self-referred patients.

Design: Review of clinic records of all individuals contacting a weight control program during a 2-year period with follow-up throughout consecutive levels of treatment (i.e., enrollment, completion, and outcome).

Setting: Medical school weight management center.

Participants: A consecutive sample (N = 1,392) of overweight and obese callers was categorized as physician-initiated (n = 345), media (n = 653), or personal (n = 394) referrals. Attendees at initial consultation (n = 571) were age 41.7 +/- 12.8 years, weight 113.9 +/- 36.1 kilograms, and body mass index (BMI) 40.3 +/- 11.3 kg/m(2) (data expressed as mean +/- standard deviation).

Interventions: Low-calorie-diet and very-low-calorie-diet programs.

Main outcome measures: Gender comparisons, attendance at initial consultation, body mass index, motivation, comorbidities, enrollment and completion rates, and weight loss.

Results: Compared to callers from other referral sources, physician referrals included a larger minority of males (25.2%) and were more likely to attend an initial consultation (63.5%; P < .001). Among consultation attendees, physician referrals were heavier (mean BMI = 44.8), reported more comorbidities, were less likely to join programs (16.9%), and scored as less motivated than other referrals (P < .007). Completion rates for physician referrals were higher than for self-referrals in the very-low-calorie-diet program (85.7%; P < .04) but not in the low-calorie-diet program (P > .05). Among completers, physician referrals did not differ on weight loss in either program (P > .05).

Conclusions: Compared to self-referrals, physician-referred individuals are in greater need of weight loss, less motivated, less likely to enter treatment, but equally likely to profit from it. Therefore, physician referral for weight loss is beneficial for at least some patients and should be encouraged.

FIGURE 1

Breakdown of data collection.

FIGURE 2

Levels of program involvement by referral source. X²s by referral group, all P < .001. Percentages in shaded ovals refer to percent of original callers. Percentages in nonshaded ovals refer to percent of needs assessment attendees.

FIGURE 3

Health conditions reported at needs assessment.

FIGURE 4

Program completion rates for VLCD and LCD programs by referral source. Note: self-referred versus physician-referred, P < .04 in VLCD, not significant in LCD. VLCD, very-low-calorie diet program; LCD, low-calorie diet program. See “Methods” for completion criteria.