JAMA offers practical suggestions for obesity treatment

Despite perceptions and clear clinical guidelines, physicians rarely discuss, diagnose, or document overweight or obesity with patients, according to a new paper published last week in the Journal of the American Medical Association (JAMA).

According to a study of about 1,500 healthcare practitioners, 97 percent say they have a responsibility to ensure patients are counseled about obesity. In another study of about 600 clinicians, 96 percent agree or somewhat agree that they should contribute to patient’s weight management, while 88 percent said moderate weight loss is extremely beneficial for obese patients, and 80 percent said obesity is a disease.

However, only 4.9 percent of primary care visits focus on weight management, according to JAMA, and some studies show a declining rate of weight counseling.

In the U.S., about 93.3 million adults are affected by obesity, according to the Centers for Disease Control and Prevention. But JAMA says even though 70 percent of adults in the U.S. have a body mass index (BMI) of greater than 25, up to 90 percent of individuals with BMIs of 30-35 do not receive a formal diagnosis of obesity. Although Medicare covers behavioral counseling for obesity, less than 1 percent receive the benefit.

Clinicians receive little training on obesity or nutrition, and few medical schools meet curriculum recommendations for nutrition and obesity education, JAMA says. Further, obesity topics are not often included on licensing examinations.

Other barriers to managing obesity in primary care included limited time, inconsistent insurance reimbursement, and general confusion by providers. JAMA suggests information overload may also be a culprit.

Evidence-based guidelines and practical resources are available to practitioners. Education and reimbursement are improving, and access to specialist referrals and community resources is increasing. JAMA says practitioners need to approach obesity with compassionate, coordinated treatment.

One approach the United States Preventive Services Task Force (USPSTF) recommends, which JAMA highlights, follows a framework known as “ABCDEF”:

  • Ask “permission”
  • Be sympathetic in the clinical workout
  • Counseling and support
  • Determine health status
  • Escalate treatment when appropriate
  • Follow up regularly and leverage available resources

Though the approach has not been formally validated in clinical studies or otherwise, it is based on published guidelines and can be useful for practitioners unsure of where to begin. Practitioners should look beyond weight loss, and recognize the stigma, shame, and depression or hopelessness that can accompany obesity diagnoses, JAMA said.

JAMA says coordinated policy in combination with environmental and societal changes are required to reduce obesity in the U.S., but clinicians have a valuable role to play in reversing this epidemic.