Doctors Should Send Obese Patients To Diet Counseling, Panel Says. But Many Don't
A visit to your primary care physician may focus on your headaches or that achy back. But if your body mass index is over 30, a panel of national experts says, it should also include a referral to an intensive weight-loss program.
That's the latest recommendation of the U.S. Preventive Services Task Force, an independent panel of national experts in disease and public health that advises primary care physicians on best practices. The group published an evidence review and the recommendation in the Journal of the American Medical Association on Tuesday.
The recommendation is identical to one made in 2012, with a few key differences. The first is the evidence: Thanks to 83 new studies published since the last recommendation, the panel is even more convinced that intensive weight loss programs — ones that last between one and two years — work.
What's "intensive"? Most programs studied lasted between one and two years and focused on changing both dietary intake and physical activity. Though the programs used different strategies for behavior change, most encouraged patients to self-monitor their weight and provided tools to help maintain weight loss, like scales, pedometers, or exercise videos. Counseling was a part of most programs, and most involved 12 or more sessions in the first year.
Since 2012, the panel also assessed all five medications approved by the Food and Drug Administration for long-term management of obesity. When paired with behavior-based programs, the panel concluded, the drugs are more effective than participating in the program alone, at least for 12 to 18 months. But the panel also noted that some of the medications have adverse side effects and that there's limited research data on weight loss medications and how well they work over the long term.
The group's main recommendation, though, remains the same: If patients are obese, their physicians should refer them to behavior-based weight loss programs or offer their own.
Sounds simple, right? Not exactly, says, Chyke Doubeni, a University of Pennsylvania primary care physician and professor of family medicine and community health who's on the USPSTF.
The Affordable Care Act requires insurance providers to cover all recommended preventive services.
But "the evidence suggests that primary care doctors are not talking to their patients about obesity and not offering them the services that could be helpful in losing weight and maintaining physical fitness," Doubeni tells NPR's Allison Aubrey.
Ashley Mason, a behavioral psychologist at the University of California, San Francisco's Biology and Experience of Eating Lab, says the reason might be time. "Those 14-minute visits with your [primary care physician] aren't enough time for everything," she says. And whenever a patient leaves their doctor's office without a plan for addressing obesity, they remain at risk for developing negative health outcomes like diabetes and hypertension.
For Debra Haire-Joshu, who directs the Center for Obesity Prevention and Policy Research at Washington University in St. Louis, the challenge is how to put the recommendations into practice. In an editorial published concurrently in JAMA Internal Medicine, she argues that the recommendations don't necessarily match up with how primary care physicians practice medicine.
Primary care doctors shouldn't feel like they have to go it alone when it comes to counseling obese patients, she says. Instead, they should refer these patients to others in the health community — like dietitians, lifestyle coaches and psychologists.
"We know what works," says Haire-Joshu. "Now we've got to find a way to deliver something better than what we're doing right now."
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