The purpose of this study was to assess inner-city clinic patient attitudes about weight loss counseling and to assess practice behaviors of primary care physicians in residency training.This is a cross-sectional survey of consecutive patients attending an outpatient internal medicine resident continuity clinic in the Bronx, New York. Participants completed a 30-item questionnaire; a 17-item Quick Weight, Activity & Excess Screener (WAVE); and 13 items to assess patients' attitudes about the physician's role in weight management. A chart review was conducted to ascertain resident practice patterns. Relationships of categorical data were evaluated using chi(2) analyses and odds ratios.Chart reviews (n = 84) indicated that 80% of patients were either obese or overweight; 21% of obese patients and 11% of overweight patients had the diagnosis documented. Of the obese patients (n = 42), 17% had dietitian referrals and 36% had an indication of physician weight loss recommendation. A patient survey indicated that 86% of obese patients wanted to lose weight, 64% wanted a dietitian referral, and 62% felt that their physician could help with weight loss. Obese patients were significantly more likely to receive weight loss recommendations than were overweight patients, but frequency of visits and the diagnosis of diabetes did not increase the likelihood that weight would be addressed.Physicians need to address how to manage obesity including assessing patient attitudes about making lifestyle changes and using dietitian and other referrals for weight reduction counseling.