• Elizabeth R Pfoh, Leslie J Heinberg, and Michael B Rothberg.
• Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA. pfohe@ccf.org.
• J Gen Intern Med. 2021 Aug 1; 36 (8): 2339-2345.

BackgroundIdentifying which patients receive referrals to and which ones attend weight management programs can provide insights into how physicians manage obesity.ObjectiveTo describe patient factors associated with referrals, which primarily reflect physician priorities, and attendance, which reflects patient priorities. We also examine the influence of the individual physician by comparing adjusted rates of referral and attendance across physicians.DesignRetrospective cohort study.ParticipantsAdults with a body mass index (BMI) ≥ 30 kg/m2 who had a primary care visit between 2015 and 2018 at a large integrated health system MAIN MEASURES: Referrals and visits to programs were collected from the EHR in 2019 and analyzed in 2019-2020. Multilevel logistic regression models were used to identify the association between patient characteristics and (1) receiving a referral, and (2) attending a visit after a referral. We compared physicians' adjusted probabilities of referring patients and of their patients attending a visit.Key ResultsOur study included 160,163 adults, with a median BMI of 35 kg/m2. Seventeen percent of patients received ≥ 1 referral and 29% of those attended a visit. The adjusted odds of referral increased 57% for patients with a BMI 35-39 (versus 30-34) and 32% for each comorbidity (p < 0.01). Attending a visit was less strongly associated with BMI (aOR 1.18 for 35-39 versus 30-34, 95% CI 1.09-1.27) and not at all with comorbidity. For the physician-level analysis, the adjusted probability of referral had a much wider range (0 to 83%; mean = 19%) than did the adjusted probability of attendance (range 27 to 34%).ConclusionsFew patients attended a weight management program. Physicians vary greatly in their probability of referring patients to programs but not in their patients' probability of attending.© 2021. Society of General Internal Medicine.

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