PACE+ Nutrition and Exercise Counseling for Obese Patients Based on Stage of Change at an Urban Primary Care Clinic

Background: Obesity screening and behavioral counseling for adults is recommended but rarely feasible to reduce the risk of developing cancer and many chronic diseases. We intiated obesity screening at an urban clinic and offered obese patients tailored counseling using PACE+, a validated tool designed for the primary care setting.

Aim: To evaluate obesity screening rates, readiness to change, preferences for change and change in BMI in patients counseled with PACE+.

Methods: Electronic medical record (EMR) review of patient data from May 2006 to March 2008. Analyses comparing stage of change to patient characteristics was conducted using the Cochran-Armitage Trend Test. Bivariate comparisons of the continuous items were analyzed using the Chi-square.

Results: Of 5,390 patients in the clinic practice, 2532 (47%) were obese, 2269 (42%) were normal or overweight, and 589 (11%) were not screened. PACE+ educators counseled 843 obese patients (33%) May 2006-March 2008. Mean age 50, mean BMI 39, 79% female and 98% African American. 31% of PACE+ participants had hypertension, diabetes mellitus and hyperlipidemia. Stage of change for exercise was most often contemplation (38%) and preparation (40%). The preferred activity was walking (62%). Most cited reasons to change behavior were to lower blood pressure, improve health, reduce weight, and increase energy. Most reported activity barriers were pain (20%), weather (13%), and time (10%). Most patients rated their stage of change for reducing calories as preparation (62%). Anticipated nutrition adherence barriers were “will-power,” cost, and time. Participants rated their self-confidence for activity and dietary changes highly. A trend to weight stabilization and weight loss was observed with follow-up.

Conclusion: Obesity screening and a structured low-intensity behavioral counseling by educators was feasible and reached 33% of obese patients in the practice. PACE+ evaluation in the EMR provides retrievable and measurable information about patient stage of change, preferences and perceived adherence barriers. This data can direct efforts to link community and personal resources to optimize behavioral and weight outcomes. Pain cited as an activity barrier by 20% needs further study.