Prevalence of obese patients in a primary care setting

Objective: Previous research has addressed the relationship between BMI and chronic disease in primary care; however, little has been done with regard to the association between obesity and depression in primary care. The purpose of this paper is to assess the relationship between obesity and chronic conditions including depression. Research Methods and Procedures : Data from primary care patients seen at a university‐based family medicine clinic in the southeastern United States were extracted for the time between January 1, 1999 and January 1, 2002. Data extracted included most recent height and weight, age, ethnicity, pregnancy status, number of office visits, blood pressure, cholesterol, hemoglobin A_1C, current diagnoses, and medications. Results : A total of 8197 patients were included in the analysis. Sixty‐nine percent of patients seen in a 3‐year period were either overweight or obese. Comparing blood pressure, cholesterol, diagnoses, and medications between BMI groups found differences in virtually all categories. Diagnoses of high cholesterol, hypertension, diabetes, and depression significantly increased for obese patients. Discussion : Obese patients are over‐represented in primary care, and this over‐representation of obesity correlates with several diagnoses, including depression. Depression is a chronic disease that may interfere with health‐related behaviors and must be addressed within the health care system.     

Familial Risk of Overweight and Obesity in the Canadian Population using the WHO/NIH Criteria

Objective: To determine the familial risk of overweight and obesity in Canada. Research Methods and Procedures: The sample was comprised of 15,245 participants from 6377 families of the Canada Fitness Survey. The risk of overweight and obesity among spouses and first‐degree relatives of individuals classified as underweight, normal weight, pre‐obese, or obese (Class I and II) according to the WHO/NIH guidelines for body mass index (BMI) was determined using standardized risk ratios. Results: Spouses and first‐degree relatives of underweight individuals have a lower risk of overweight and obesity than the general population. On the other hand, the risk of Class I and Class II obesity (BMI 35 to 39.9 kg/m²) in relatives of Class I obese (BMI 30 to 34.9 kg/m²) individuals was 1.84 (95% CI: 1.27, 2.37) and 1.97 (95% CI: 0.67, 3.25), respectively, in spouses, and 1.44 (95% CI:1.10, 1.78) and 2.05 (95% CI: 1.37, 2.73), respectively in first‐degree relatives. Further, the risk of Class II obesity in spouses and first‐degree relatives of Class II obese individuals was 2.59 (95% CI: ?0.91, 6.09) and 7.07 (95% CI: 1.48, 12.66) times the general population risk, respectively. Discussion: There is significant familial risk of overweight and obesity in the Canadian population using the BMI as an indicator. Comparison of risks among spouses and first‐degree relatives suggests that genetic factors may play a role in obesity at more extreme levels (Class II obese) more so than in moderate obesity.     

The Canadian Obesity Epidemic: An Historical Perspective

Objective: To examine temporal trends in stature, body mass, body mass index (BMI), and the prevalence of overweight and obesity in Canada. Research Methods and Procedures: Data for adults 20 to 64 years of age were compared across eight Canadian surveys conducted between 1953 and 1998. Temporal trends in stature and body mass were examined using regression, and changes in weight‐for‐height were expressed as changes from 1953. BMI data were available from 1970 to 1972 to examine changes in overweight and obesity. Qualitative changes in the BMI distribution were examined using Tukey mean‐difference plots. Results: Significant temporal trends in stature and body mass have occurred since 1953 in Canada. Median stature increased 1.4 cm/decade in men and 1.1 cm/decade in women, whereas median body mass increased 1.9 kg/decade in men and 0.8 kg/decade in women. Increases in the 75th percentile of body mass were larger than the median. The average weight‐for‐height increased 5.1% in men and 4.9% in women from 1953. Furthermore, the prevalences of overweight and obesity have increased from 40.0% and 9.7% in 1970–1972 to 50.7% and 14.9% in 1998, respectively. The entire BMI distribution has shifted to the right since 1970–1972 and has become more skewed to the right for men than for women. Discussion: There have been significant increases in stature and body mass in Canada over the last 45 years. Body mass has increased more than stature, particularly in the upper percentiles, which has resulted in the currently observed high prevalences of overweight and obesity.     

Moderate and Severe Obesity Have Large Differences in Health Care Costs

Objective: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old. Research Methods and Procedures: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days. Results: The results indicated that there were large differences in obesity‐related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (～100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services. Discussion: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.     

Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents

Objectives: The present study aims to evaluate the accuracy of the index of waist‐to‐height ratio (WHTR), and proposed the optimal thresholds of WHTR in the definition of childhood overweight and obesity in a bi‐ethnic Chinese school‐aged population. Research Methods and Procedures: Overweight and obese were identified by BMI for age and gender in a random sample including 2055 Han and 2132 Uygur ethnic school‐aged children (8 to 18 years old). WHTR was calculated by waist circumference divided by height on the basis of standard anthropometric measurements. Receiver operating characteristic (ROC) curve analyses were performed to assess the accuracy of WHTR as a diagnostic test for childhood overweight and obesity, compared with waist circumference. The optimal thresholds of WHTR for defining overweight and obesity were recommended respectively by gender. The correlation between WHTR and age was analyzed and compared with BMI. Results: A‐values (area under curve) of WHTR for diagnosing overweight and obesity were both over 0.90 in both genders and better than those of waist circumference. A threshold of 0.445 was identified for overweight in both genders, with the sensitivity and specificity >0.80. The thresholds for defining obesity was 0.485 in boys and 0.475 in girls, both having the sensitivity and specificity >0.90. WHTR showed less association with age than BMI. Conclusions: WHTR is a simple, easy, accurate, and non‐age‐dependent index with high applicability to screening overweight and obesity in children and adolescents. The use of WHTR in the general childhood population has been justified by this study.     

Geographic and Demographic Variation in the Prevalence of Overweight Canadian Children

Objective : To examine the geographic and demographic variation in the prevalence of overweight Canadian children. Research Methods and Procedures : Using BMI data from the 1981 Canada Fitness Survey and the 1996 National Longitudinal Survey of Children and Youth, this study assessed: 1) the prevalence of overweight and obesity among Canadian boys and girls ages 7 to 13 years; 2) secular trends in the prevalence of overweight from 1981 to 1996, by province and adjusted for age and sex; and 3) provincial variation in the prevalence of overweight, before and after adjusting for socioeconomic and demographic characteristics. Results : The prevalence of boys and girls classified as overweight in 1996 was 33% and 26%, respectively. The corresponding figures for obesity were 10% for boys and 9% for girls. Provincial variation was observed with a trend of increasing risk of being overweight from west to east. Socioeconomic status was inversely related to the prevalence of overweight regardless of geographic region. The risk of being overweight was more related to geography (province) than demographic variables (income and family background); however, the effect of secular trends (1981 to 1996) exceeded the effect of geographic or demographic variables. Discussion : The prevalence of childhood overweight and obesity is increasing in all areas of Canada and can be explained only partially by geographic or demographic characteristics.     

The Relationship between Body Weight and Health Care among German Women

Objective: To investigate the relationship between body weight and the use of health care services among women from southern Germany. Research Methods and Procedures: Data were drawn from the 1994 to 1995 Monitoring of Trends and Determinants in Cardiovascular Disease Augsburg survey, covering a population‐representative sample of women 25 to 74 years old (n = 2301). Logistic regression models were used to calculate odds ratios (ORs) for the use of medical services by women with overweight (BMI 25.0 to 29.9 kg/m²) or obesity (BMI ≥ 30 kg/m²) in comparison with normal‐weight women (BMI < 25.0 kg/m²). Results: In multivariable analysis, obese women 50 to 74 years old were more likely than normal‐weight women to delay cancer screening procedures, such as manual breast examination and Papanicolaou smear (OR 0.52, 95% confidence interval 0.37 to 0.74) in the previous 12 months. However, the relationship between obesity and cancer screening was not found to be significant in 25‐ to 49‐year‐old women (OR 0.92, 95% confidence interval 0.62 to 1.36). Neither in the 25‐ to 49‐year‐old age group nor in the 50‐ to 74‐year‐old age group were independent relationships between higher body weight and total physician visits, hospitalizations, or medication use observed. Discussion: Obese women tended to use medical services with greater frequency due to obesity‐related diseases. However, postmenopausal women with a BMI ≥ 30 kg/m² were more likely to delay routine cancer screening, putting them at a greater risk for death from breast, cervical, and endometrial cancer. Thus, obese postmenopausal women should be targeted for increased screening.     

Trends in overweight from 1980 through 2001 among preschool-aged children enrolled in a health maintenance organization

Objective: To examine overweight trends over a 22‐year period among preschool‐aged children from primarily middle‐income families enrolled in a health maintenance organization. Research Methods and Procedures: From well‐child care visits to a Massachusetts health maintenance organization, we randomly selected one visit per child per calendar year, yielding a study sample of 120,680 children seen at 366,109 visits from 1980 through 2001. Using multivariate logistic regression models accounting for repeated observations of individual children across years, we estimated trends in prevalence of overweight (weight‐for‐length/height ≥ 95th percentile) and at‐risk‐for‐overweight (85th to 95th percentile). Results: Over the 22‐year study period, the observed prevalence of overweight increased from 6.3% to 10.0% and at‐risk‐for‐overweight increased from 11.1% to 14.4%. These increases were evident among all groups of children including infants < 6 months of age. Overall, the adjusted odds ratios were 1.21 per decade (95% confidence interval, 1.17 to 1.25) for overweight and 1.06 per decade (95% confidence interval, 1.03 to 1.08) for at‐risk‐for‐overweight. Discussion: Rates of overweight are increasing in very young children, even infants, from primarily middle‐class families.     

Obesity and Physical and Emotional Well‐Being: Associations between Body Mass Index,Chronic Illness,and the Physical and Mental Components of the SF‐36 Questionnaire

Objective: To clarify the associations between obesity and health‐related quality of life by exploring the associations between physical and emotional well‐being in relation to obesity and the presence of other chronic illness. Research Methods and Procedures: The study data were collected as part of a postal‐survey within the old Oxford Regional Health Authority of England in 1997. Completed questionnaires were returned by 8889 of 13,800 randomly selected adults aged 18 to 64 years. The main outcome measures were body mass index in five categories (underweight, normal weight, overweight, moderately obese, morbidly obese); chronic illness status (any vs. none and number of such illnesses 0, 1 to 2, 3+); and mean SF‐36 questionnaire score in two summary component measures reflecting physical and emotional well‐being. Results: Of the subjects, 31% were overweight and an additional 11% were obese. Body mass index was significantly associated with health status, but the pattern varied according to whether the measure reflected physical or emotional well‐being. Physical, but not emotional, well‐being deteriorated markedly with increasing degree of overweight and was limited in subjects who were obese but had no other chronic condition; subjects with chronic illnesses other than obesity were compromised in both dimensions. In terms of the number of chronic illnesses reported, the additional presence of obesity was associated with a significant deterioration in physical but not emotional well‐being. Discussion: Overweight and obesity are associated with poor levels of subjective health status, particularly in terms of physical well‐being. The limitations in emotional well‐being that are reported here and in other studies may be a result of confounding by the presence of accompanying chronic illness.     

Prevalence and determinants of obesity in children in public schools of Sintra, Portugal

Objective: To assess the prevalence of and the factors related to overweight and obesity in a sample of children from the region of Sintra, Portugal. Methods and Procedures: Cross‐sectional study, stratified for freguesia with random selection of schools. Height, weight, triceps skinfold, upper arm and waist circumferences were measured, and overweight/obesity defined according to international criteria. Breast‐feeding, number of daily meals and parents' height and weight data were also collected. Results: One thousand two hundred and twenty‐five children aged 6–10 years were assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and 12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm circumference, arm muscle area, and waist circumference than their normal weight counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78 (95% confidence interval (CI): 1.76–4.38), while a child with two obese progenitors had a risk multiplied by 6.47 (95% CI: 5.59–16.19). Conversely, being picky was significantly related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.04–0.63); for girls, OR = 0.19 (95% CI: 0.06–0.64). Finally, no relationships were found between obesity, birth weight, birth height or breast‐feeding. Discussion: Prevalence of overweight and obesity are elevated among children of the Sintra region in Portugal compared to most other regions of Europe. The relationship with the parents' nutritional state stresses the need to target families for preventing obesity.     

Profile of Overweight and Obese People in a Mediterranean Region

Objective: To assess the prevalence of excess weight (obesity and overweight) and the related environmental risk factors in a Mediterranean population. Self‐perception of body weight, attitudes toward weight‐control behaviors, and the associated factors were also examined. Research Methods and Procedures: A cross‐sectional nutritional survey was carried out in the Balearic Islands between 1999 and 2000. A random sample (n = 1200) of the adult population (20 to 60 years old) was interviewed. Dietary questionnaires and a global questionnaire incorporating questions related to sociodemographic and lifestyle variables were utilized. Anthropometric measurements were also obtained. Results: Nearly one‐half of the population of the Balearic Islands is above the normal weight range (BMI > 25). The predictors of overweight and obesity in the Balearic Islands are to be over 40 years old, to be married, to form part of the lowest educational levels, and to have a sedentary lifestyle. A large percentage of excess‐weight individuals tend to underestimate their BMI, are not concerned about their weight status, tend to snack more often, and have never dieted. Discussion: Although the likely causes of the rise in obesity prevalence are difficult to elucidate from this study, we have identified the profile of individuals with excess weight in the Balearic Islands as well as their attitudes toward their body image.     

Cut‐off Point of BMI and Obesity‐Related Comorbidities and Mortality in Middle‐Aged Koreans

Objective: The need for a lower BMI to classify overweight in Asian populations has been controversial. Using both disease and mortality outcomes, we investigated whether lower BMI cut‐off points are appropriate for identifying increased health risk in Koreans. Research Methods and Procedures: We conducted a cohort study among 773, 915 men and women from 30 to 59 years old with 8‐ to 10‐year follow‐up periods. Primary outcomes were change of obesity prevalence, obesity‐related disease incidence, and all‐cause mortality. Results: Prevalence of overweight (BMI of 25.0‐29.9) has steadily increased (1.3% annually), whereas obesity (BMI ≥ 30) showed a lower prevalence and only a slight increase (0.1%‐0.2% annually). Our study revealed that dose‐response relationships exist between obesity and related disease incidences (hypertension, type 2 diabetes, and hypercholesterolemia) beginning at lower BMI levels than previously reported. Compared with those in the healthy weight range, Koreans with a BMI ≥ 25 were not at greater risk of hypertension, type 2 diabetes, or hypercholesterolemia than has been reported for whites in similar studies. Obesity‐related all‐cause mortality also did not seem so different from that of whites. Discussion: Our findings did not support the use of a lower BMI cut‐off point for defining overweight in Koreans compared with whites for the purpose of identifying different risks. However, populations with BMI ≥ 25 are rapidly increasing and have substantial risks of diseases. To preempt the rapid increases in obesity and related health problems that are occurring in Western countries, Korea should consider using a BMI of 25 as an action point for obesity prevention and control interventions.     

Geographic Variation in the Prevalence of Obesity,Diabetes, and Obesity‐Related Behaviors**

Objective: To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss counseling by health providers and in other potential obesity‐related determinants in 100 metropolitan statistical areas in the United States. Research Methods and Procedures: We performed a cross‐sectional study using data from the 2000 Behavioral Risk Factor Surveillance System, the largest telephone survey of health behaviors in the United States, of age‐adjusted prevalence of obesity, type 2 diabetes, intake of ≥five servings of fruits and vegetables per day, participation in 150 minutes of leisure‐time physical activity per week, receipt of weight management advice, and reports of trying to lose or maintain weight among men and women more than 18 years old. Results: The age‐adjusted prevalence of obesity ranged from 13.1% to 30.0% and that of type 2 diabetes from 3.3% to 9.2%. Among participants who had visited a physician for a routine checkup in the previous 12 months, 13.1% to 27.1% of all participants recalled receiving advice from a health professional about their weight, and 11.7% to 34.6% of overweight or obese participants recalled receiving advice to maintain or lose weight. Discussion: Significant differences in the prevalence of obesity and self‐reported type 2 diabetes and in medical practice patterns regarding weight management advice exist among metropolitan statistical areas. These results suggest important opportunities to investigate reasons for these variations that could potentially be used to mitigate the current epidemic of obesity and to identify areas where obesity and diabetes prevention efforts may need to be targeted.     

An Observational Study of Slimming Behavior in Denmark in 1992 and 1998

Objective: To elucidate how frequent weight‐loss attempts are made, the methods used to achieve weight loss, and the extent to which the outcome is positive. Research Methods and Procedures: Two independent interviews were conducted in 1992 and in 1998, each with 1200 randomly selected adult subjects. Each survey was designed to ensure an equal distribution of age, gender, and geographical regions in Denmark. Results: The proportion of subjects having attempted weight loss did not change from 1992 to 1998, although the prevalence of overweight and obesity increased from 1992 (overweight, 30%; obesity, 6%) to 1998 (overweight, 35%; obesity, 8%). Almost twice as many women (61%) than men (32%) had attempted weight loss (p < 0.0001). Slimming occurred more often in subjects <50 years (51%) than >50 years (39%) (p < 0.0001), although overweight and obesity were more frequent in the elderly. Over‐the‐counter diet pills or meal replacements were associated with a negative outcome of slimming treatment (p < 0.0001). Discussion: Approximately half of all adult Danes have attempted weight loss, particularly women and individuals <50 years. This finding is inconsistent with the fact that overweight and obesity are more prevalent in men and in individuals >50 years. Changes in habitual diet and increased physical activity are the most prevalent modes of slimming, whereas the use of over‐the‐counter diet pills or meal replacements has decreased from 1992 to 1998. This development may have a positive impact on future body‐ weight‐management strategies.     

Current Estimates of the Economic Cost of Obesity in the United States

This study was undertaken to update and revise the estimate of the economic impact of obesity in the United States. A prevalence-based approach to the cost of illness was used to estimate the economic costs in 1995 dollars attributable toobesity for type 2 diabetes mellitus, coronary heart disease (CHD), hypertension, gallbladder disease, breast, endometrial and colon cancer, and osteoarthritis. Additionally and independently, excess physician visits, work-lost days, restricted activity, and bed-days attributable to obesity were analyzed cross-sectionally using the 1988 and 1994 National Health Interview Survey (NHIS). Direct (personal health care, hospital care, physician services, allied health services, and medications) and indirect costs (lost output as a result of a reduction or cessation of productivity due to morbidity or mortality) are from published reports and inflated to 1995 dollars using the medical component of the consumer price index (CPI) for direct cost and the all-items CPI for indirect cost. Population-attributable risk percents (PAR%) are estimated from large prospective studies. Excess work-lost days, restricted activity, bed-days, and physician visits are estimated from 88,262 U. S. citizens who participated in the 1988 NHIS and 80,261 who participated in the 1994 NHIS. Sample weights have been incorporated into the NHIS analyses, making these data generalizable to the U. S. population. The total cost attributable to obesity amounted to $99. 2 billion dollars in 1995. Approximately $51. 64 billion of those dollars were direct medical costs. Using the 1994 NHIS data, cost of lost productivity attributed to obesity (BMI≥30) was $3. 9 billion and reflected 39. 2 million days of lost work. In addition, 239 million restricted-activity days, 89. 5 million bed-days, and 62. 6 million physician visits were attributable to obesity in 1994. Compared with 1988 NHIS data, in 1994 the number of restricted-activity days (36%), bed-days (28%), and work-lost days (50%) increased substantially. The number of physician visits attributed to obesity increased 88% from 1988 to 1994. The economic and personal health costs of overweight and obesity are enormous and compromise the health of the United States. The direct costs associated with obesity represent 5. 7% of our National Health Expenditure in the United States .     

Prevalence of obesity in elementary schoolchildren living in Northeast Attica, Greece

Objective: To assess the prevalence of obesity and obesity trend in schoolchildren living in Northeast Attica, Greece. Research Methods and Procedures: Mean (standard deviation) and median weight and BMI were calculated in 4131 (2054 boys and 2077 girls) 6‐ to 11‐year‐old Greek schoolchildren living in Northeast Attica between November 2003 and April 2004. Two hundred thirty‐six (95 boys, 141 girls) immigrant children also participated in the study. The secular trend for obesity was determined comparing our data with those of a similar study performed in 1994. Results: Of boys, 27.8% were overweight, and 12.3% were obese. For girls, the corresponding values were 26.5% for overweight and 9.9% for obesity. There was an increase in the prevalence of overweight and obesity in the last 10 years in both sexes. For boys, overweight increased by 4.2% and obesity by 2.9%, whereas, for girls, overweight increased by 3.8% and obesity by 1.6%. Overweight and obesity were less prevalent in the immigrant children compared with their Greek peers. For immigrant boys, overweight was 15.9% and obesity was 7.9%, and for immigrant girls, overweight was 15.2% and obesity was 8.7%. Discussion: Greek schoolchildren living in Northeast Attica present a high prevalence of overweight and obesity and a positive secular change in the prevalence of obesity.     

Changes in Prevalence of Overweight and in Body Image among Fijian Women between 1989 and 1998**

Objective: To investigate changes in prevalence of overweight and obesity and in body image among ethnic Fijian women in Fiji during a period of rapid social change and the relationship between changes in body image and BMI. Research Methods and Procedures: The study design was a multiwave cohort study of BMI in a traditional Fijian village over a 9.5‐year period from 1989 to 1998. Cohorts were identified in 1989 (n = 53) and in 1998 (n = 50). Selection criteria included Fijian ethnicity, female gender, age of at least 18 years, and residence in a specific coastal Fijian village in 1989 and 1998, respectively. Assessments consisted of measurement of height and weight, collection of demographic data by written survey, and administration of the Nadroga Language Body Image Questionnaire. Results: The prevalence of overweight and obesity was significantly different between the cohorts, increasing from 60% in 1989 to 84% in 1998 (p = 0.014). In addition, the age‐adjusted mean BMI was significantly higher in 1998 compared with 1989 (p = 0.011). Finally, there were significant between‐cohort differences in multiple measures of body image, which were mostly independent of BMI. Discussion: At 84%, the prevalence of overweight and obesity in this community sample of Fijian women is among the highest in the world. The dramatically increased prevalence over the 9.5‐year period studied corresponds with rapid social change in Fiji and significant shifts in prevailing traditional attitudes toward body shape.     

Adult Obesity and Office‐based Quality of Care in the United States

Nationally representative data on the quality of care for obese patients in US‐ambulatory care settings are limited. We conducted a cross‐sectional analysis of the 2005 and 2006 National Ambulatory Medical Care Survey (NAMCS). We examined obesity screening, diagnosis, and counseling during adult visits and associations with patient and provider characteristics. We also assessed performance on 15 previously published ambulatory quality indicators for obese vs. normal/overweight patients. Nearly 50% (95% confidence interval (CI): 46–54%) of visits lacked complete height and weight data needed to screen for obesity using BMI. Of visits by patients with clinical obesity (BMI ≥30.0 kg/m²), 70% (66–74%) were not diagnosed and 63% (59–68%) received no counseling for diet, exercise, or weight reduction. The percentage of visits not being screened (48%), diagnosed (66%), or counseled (54%) for obesity was also notably higher than expected even for patients with known obesity comorbidities. Performance (defined as the percentage of applicable visits receiving appropriate care) on the quality indicators was suboptimal overall. In particular, performance was no better than 50% for eight quality indicators, which are all related to the prevention and treatment of obesity comorbidities, e.g., coronary artery disease, hypertension, hyperlipidemia, asthma, and depression. Performance did not differ by weight status for any of the 15 quality indicators; however, poorer performance was consistently associated with lack of height and weight measurements. In conclusion, many opportunities are missed for obesity screening and diagnosis, as well as for the prevention and treatment of obesity comorbidities, in office‐based practices across the United States, regardless of patient and provider characteristics.