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→ "Obesity is a serious problem in the United States. More that one-third of American adults are now obese."
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Part 1
Issues of weight and obesity in primary care
Ask any primary care provider. Obesity and issues related to exercise and diet are the most difficult to change and among the most prevalent in any practice. Even outside the professional sphere, everyone knows someone who, despite admirable efforts, continues to struggle with serious weight problems.
Primary care is an appropriate setting for managing many chronic conditions. Its longitudinal practice of medicine, the trust that PCPs build with patients they see, and in some practices, a Behavioral Health Provider, may seem ideal to handle this intractable issue. But modern PC practices are also fast-paced and mostly limited to brief encounters. Obesity cannot be cured in a fifteen-minute consult.
A public health concern
Obesity is prevalent and intransigent. These are issues that are not responsive to quick fixes.
The U.S. Preventive Services Task Force is a trusted and independent group of national experts in evidence-based medicine. The USPSTF notes:
Since 1976 to 1980, the prevalence of obesity and overweight in the United States have increased by 134% and 48%, respectively. In 2007 to 2008, 40% of men and 28% of women in the United States were overweight and 32% of men and 36% of women were obese. The prevalence of obesity exceeds 30% in most age- and sex-specific groups, with approximately 1 in 20 Americans having a BMI greater than 40 kg/m.Depending on age and race, obesity has been shown to be associated with a 6- to 20-year decrease in life expectancy. The leading causes of death in obese adults include ischemic heart disease, diabetes, certain types of cancer (for example, liver, kidney, breast, endometrial, prostate, and colon), and respiratory diseases.
In June 2012, the Task Force issued recommendations on screening and management of obesity in adults. You can download a summary HERE. The key recommendation for those patients whose body mass screening results are greater than 30kg/m2 is that they be referred to an intensive, multicomponent behavioral intervention.
“You need to lose some weight”
Of course, providers want to help. The USPSTF and the NIH have issued many concrete suggestions for successful weight loss, but the end results are too often that patients feel a grave sense of shame when they have to report failure or relapse again and again. Patients who struggle with their weight are unlikely to respond well to trim and fit providers outlining their personal success stories. A mini-lecture about the amount of sugar in soda and telling patients to avoid those sugary drinks may lead to dropping a few pounds, but such clear wins are rare and don’t address any increase in physical activity. Weight is deeply personal. It is something everyone sees about you, and often judges. You are reminded of the problem and your failures each time you confront the mirror.
So where are these intensive, multicomponent behavioral interventions?
The National Diabetes Prevention Program (NDPP) is a nationally recognized and widely available behavioral intervention for diabetes prevention and control. Since it’s focus is weight loss, it is an appropriate tool for addressing obesity whether or not DM is a present concern. In many ways, it is the gold standard for weight loss programs such as those suggested by the USPSTF.
From NIH National Institute of Diabetes and Digestive and Kidney Diseases
Click HERE for link
Safe and successful weight-loss programs should include
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- behavioral treatment, also called lifestyle counseling, that can teach you how to develop and stick with healthier eating and physical activity habits—for example, keeping food and activity records or journals
- information about getting enough sleep, managing stress, and the benefits and drawbacks of weight-loss medicines
- ongoing feedback, monitoring, and support throughout the program, either in person, by phone, online, or through a combination of these approaches
- slow and steady weight-loss goals—usually 1 to 2 pounds per week (though weight loss may be faster at the start of a program)
- a plan for keeping the weight off, including goal setting, self-checks such as keeping a food journal, and counseling support
The most successful weight-loss programs provide 14 sessions or more of behavioral treatment over at least 6 months—and are led by trained staff.2
If online:
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- organized, weekly lessons, offered online or by podcast, and tailored to your personal goals
- support from a qualified staff person to meet your goals
- a plan to track your progress on changing your lifestyle habits, such as healthy eating and physical activity, using tools such as cellphones, activity counters, and online journals
- regular feedback on your goals, progress, and results provided by a counselor through email, phone, or text messages
- the option of social support from a group through bulletin boards, chat rooms, or online meetings
Once primary care teams understand what constitutes the multicomponent behavioral interventions for weight and obesity, they can research programs in the community and online that match these suggestions. Weight Watcherstm, Curvestm, and YMCAs that sponsor their Weight Loss Program are possible starting points; they are programs that match many of the NIH guidelines.
