Overcoming Challenges to Obesity Counseling: Suggestions for the Primary Care Provider
Journal of Clinical Outcomes Management. 2014 March;21(3)
References
schedule a time to discuss weight loss at a later date. Sometimes PCPs can miss these opportunities [83]. When a patient’s chief complaint is not related to obesity, then providers should minimize or avoid discussions of obesity. Obese patients may misconstrue such discussions as being motivated by negative provider judgment [84]. Second, providers should inquire about the patient’s belief about their weight and interest in weight loss. For patients interested in a weight discussion, providers should not be afraid to use the term “obese” or “obesity.” A recent study showed that obese patients actual prefer that PCPs use the term “obese” rather than another euphemism, as it suggested to patients that the problem had more serious consequences [85]. PCPs should also emphasize the collaborative nature of creating a weight loss plan and the autonomy of the patient, as well as evocate or draw out the patient’s own reasons for change. These techniques are essential features of motivational interviewing [86]. If acceptable, the PCP can then begin to negotiate lifestyle changes and set goals with the patient, consider weight loss medications or bariatric surgery if appropriate, or refer to a local weight management or community program. Finally, PCPs should schedule a short-term follow-up with all patients to assess their success and challenges with implementing the agreed upon changes.
Summary
Given the obesity epidemic, PCPs will need to begin addressing weight loss as a part of their normal practice; however, providers face several challenges in implementing weight management services. Many PCPs report receiving inadequate training in weight management during their training; however, many CME opportunities exist for providers to reduce their knowledge and skills deficit. Depending upon the prevalence of obesity in their practice and interest in offering weight management services, PCPs may need to consider more intensive weight management training or even pursue certification as an obesity medicine provider through the American Board of Obesity Medicine. For providers with a more general interest in obesity counseling, applying a consistent counseling approach like the 5A’s to several behaviors (eg, obesity, smoking cessation) may facilitate such counseling as a regular part of the outpatient encounter. PCPs should also be aware of different cultural considerations with respect to obesity including different body image perceptions and cooking styles. Obesity bias is pervasive in our society; therefore, PCPs may similarly hold negative explicit or implicit attitudes towards these patients. Providers can engage in online self-assessment about their explicit and implicit biases in order to understand whether they hold any negative attitudes towards obese patients. Additional training in communication skills and empathy may improve these patient-provider relationships and translate into more effective behavioral counseling. PCPs may be concerned about a lack of reimbursement for weight management services or a lack of time to perform counseling during outpatient encounters. With the new obesity counseling benefits coverage by CMS, PCPs should be reimbursed for obesity counseling services and provide additional time through dedicated weight management visits for Medicare patients. The new primary care practice models including the patient-centered medical home may facilitate PCP referrals to other weight management providers such as registered dieticians and health coaches, which could offset the PCP’s time pressures. Finally, PCPs can consider referrals to community resources, such as programs like Overeaters Anonymous, TOPS or the YMCA, to help provide patients group support for behavior change. In summary, PCPs may need to consider additional training to be prepared to deliver high quality obesity care in collaboration with other local partners and weight management specialists.
