Clinical Review

Overcoming Challenges to Obesity Counseling: Suggestions for the Primary Care Provider

Journal of Clinical Outcomes Management. 2014 March;21(3)

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Surveys of obese patients and their doctors indicate that PCPs may not often enough refer patients to structured weight loss programs or registered dietitians [75,76]. Furthermore, PCPs are often isolated from other providers who might be important in a team-based model of obesity care, such as pharmacists, registered dietitians, endocrinologists, and bariatric surgeons. The implementation of the Affordable Care Act, including payment reform and the rise of accountable care organizations, should begin changing the relative isolation of the PCP. If more practices attempt to conform to medical home models, the interconnectedness of PCPs to other health care team members may increase, thus facilitating a more team-based approach to obesity care and easier referrals to specialized team members [77].

Weight Management Resources

Aside from some academic centers and large private health care institutions, many primary care practices lack access to structured obesity care clinics that can help manage the challenges of guiding patients through their weight loss options. For providers who practice in areas that do not afford them easy access to obesity care clinics, it is worth seeking out available resources in the nonmedical community that might provide a structured support system for patients. One low-cost community-based program, Take Off Pounds Sensibly (TOPS; www.tops.org), can achieve and sustain a 6% weight loss for active members [78]. Groups such as Overeaters Anonymous are found in most U.S. cities, and have helpful websites including podcasts that patients can access even in the absence of a local branch (www.oa.org). Organizations like the YMCA, which have good penetration into most areas of the country, offer affordable access to physical activity and health programs including coaching that can promote all around healthier living and improved dietary habits (www.ymca.net). A final consideration could be referral to a commercial weight loss program. A 2005 review of the major U.S. commercial weight loss programs concluded that there was suboptimal evidence for or against these programs’ efficacy [79]. A recent randomized controlled trial showed that patients referred by their PCP to a commercial weight loss program (Weight Watchers) lost significantly more weight (2.3 kg) at 12 months as compared to patients who only received weight loss advice from their PCP [80]. However, it is important to keep in mind that not all commercial programs are the same and some programs can be ineffective or even dangerous for some patients. The PCP may need to take an active role monitoring their patient’s health and safety when using these programs.

A Strategy to Incorporate Weight Management into Current Practice

While seeking additional training is a good option, PCPs can incorporate some strategies into their current routines with obese patients as outlined in Table 2 , which integrates aspects of motivational interviewing with the 5A’s strategy discussed above into a practical framework. Many of these elements are grounded in psychological theory and supported by evidence [81,82]. First, PCPs should plan to specifically discuss weight loss and dedicate time to discuss this issue with their obese patients. This task may be more easily accomplished during the patient’s annual physical where providers typically allocate longer time for the appointment and patients may be more likely to anticipate a discussion of preventive health issues. However, if the patient raises the issue, providers need to be prepared to address weight loss or at least