Toolkit provides guidelines for weight loss counseling in primary care

Healthcare practitioners and researchers have a new tool to combat obesity in primary care settings, according to a new study published in the journal Obesity.

In 2011, the Centers for Medicare and Medicaid Services (CMS) began covering intensive behavioral therapy (IBT) for obesity when provided to qualified beneficiaries in primary care settings. The benefit provides weekly 15-minute visits the first month, followed by every-other week visits in months two through six. Patients who lose three kilograms at month six are eligible for monthly 15-minute visits in months seven through 12 to facilitate weight loss maintenance. This sums to a maximum of 22 possible visits in one year.

Thomas Wadden, PhD, co-author and professor of psychology in psychiatry at the Perelman School of Medicine in Philadelphia, Pennsylvania write the IBT benefit for obesity represents a major advance in recognizing the perils of obesity and the health benefits of moderate weight loss. However, CMS has not provided an evidence-based treatment manual for physicians and other qualified practitioners to use in delivering IBT to patients. CMS recommends that practitioners follow a 5A approach (assess, advise, agree, assist, and arrange) in providing weight management, but the efficacy of this approach is not well-established.

The new toolkit includes a 21-session treatment manual, which is modeled on the schedule of visits recommended by CMS. The manual is adapted from the widely used Diabetes Prevention Program. In a randomized assessment of this brief IBT approach, modeled on the CMS schedule, participants lost a mean of 5.4 percent of initial weight at six months, which increased to 6.1 percent at one year, Wadden said.

The authors also encourage CMS to expand the range of practitioners who can provide IBT to include registered dietitians (RD), health counselors, psychologists, and other allied health professionals. Currently some of these practitioners can deliver services incident to CMS-approved providers, who include physicians, nurse practitioners, nurse specialists, and physician assistants.

However, a CMS-approved provider must be physically present at the time an RD or other auxiliary professional delivers care, thus, limiting the opportunity to do so. The authors also call for the coverage of remotely delivered IBT, where shown to be effective.