Conversations about Weight Loss can Promote Behavior Change in Patients

Conversations about Weight Loss Can Promote Behavior Change in Patients

With the rising prevalence of obesity, physicians need to focus on teaching patients about healthy lifestyle behaviors, especially weight management.

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With multiplying documentation demands and population health goals, physicians bear much more responsibility than they did in previous years. A main advantage of outsourcing medical transcription is that it allows physicians to focus their attention on the clinical relationship with the patient and spend more time with them. One of the areas that physicians need to focus on is teaching patients about healthy lifestyle behaviors, especially weight management.

According to the statistics cited by the Centers for Disease Control and Prevention (CDC), obesity affected 39.8% of Americans (about 93.3 million adults) in 2015-2016. Patients need to be made aware of the necessity to reduce their weight, as extra weight is linked to diseases such as diabetes, sleep apnea, high blood pressure, stroke and some types of cancers. Communication is the first step to help patients take control of their weight.

In 2013, the American Medical Association (AMA) declared obesity a disease, making it important that all physicians collaborate with dietitians and other health care professionals to screen for, diagnose, treat, manage, and prevent obesity, just as they do other diseases.

A 2014 study of National Health and Nutritional Examination Survey (NHANES) data reported that patients whose physicians had informed them that they were overweight were much more likely to make healthy lifestyle changes to lose weight. The team concluded that people who are overweight and aware about this would not change their current behaviors unless physicians talked about their weight. It is therefore the physician’s responsibility to raise the issue. However, physicians face many challenges when it comes to engaging with patients about their weight:

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Weight is not an easy subject: Weight is a complex and sensitive issue, and physicians find it difficult to broach the topic with their patients. Many providers are not sure about what words to use when talking about weight, while supporting their patients in an empowering and nonjudgmental manner

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Lack of nutrition education and training: Medical education does not provide physicians with knowledge about nutrition. Medical professionals do understand nutrition science, but most do not know how to translate it into practical advice for patients, such as what foods to avoid and how to cook, says David Eisenberg, MD, associate professor of Nutrition at Harvard T.H. Chan School of Public Health and executive vice president for Health Research and Education at the Samueli Institute.

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Time constraints: Providers may not have enough time for such conversations at the appointment. In a 2018 NPR article, Ashley Mason, a behavioral psychologist at the University of California, San Francisco's Biology and Experience of Eating Lab points out that 14-minute visits with the primary care physician “aren't enough time for everything”.

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Insufficient reimbursement: This is actually no longer a reason for not providing weight management counseling. Starting November 2011, CMS began reimbursing primary care physicians for obesity counseling by introducing Healthcare Common Procedure Coding System (HCPCS) code G0447, Face-to-face behavioral counseling for obesity, 15 minutes. Providers can bill for weight management counseling provided therapy for obesity meets CMS guidelines and is consistent with the 5-A (assess, advise, agree, assist and arrange) framework delineated by the US Preventive Services Task Force (USPSTF).

According to CMS, therapy for obesity consists of: -

Screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters (expressed kg/m2)

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Dietary (nutritional) assessment; and

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Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise.

Not discussing a plan to address obesity at the office visit increases patients’ risks of developing or aggravating conditions like diabetes and high blood pressure, leading in turn, to negative health outcomes. Even moderate, 5‐10% sustained weight loss can improve health.

How can physicians talk to patients about weight management? A health.gov article written on behalf of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers the following guidance: o

Initiate the discussion about weight in a respectful and nonjudgmental way.

Using terms patients prefer may improve patient communication and care.

Surveys show that patients prefer “weight” and “BMI” and dislike “fatness,” “excess fat,” and “obesity.”

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Dietary advice should take account of the patient’s culture, including perceptions about weight, favorite foods, social norms and practices, and related issues. Researchers say that asking patients about their goals, ideal

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body type, comfort with physical activity, diet advice and other issues can make individualized weight management counseling much more effective. o

Physicians should ask questions that promote dialogue. This will encourage even patients to not ready to attempt weight loss to think about making positive lifestyle changes.

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When patients are willing to change habits, the physician should focus on initiating action by working with them to create and implement a plan to improve their health. Those who are not ready to commit to a weight loss plan can be advised on avoiding further weight gain by reducing consumption of sugary foods, unhealthy fats, and salt.

The NPR article draws attention to the latest USPSTF recommendation that treatment plans for a patient whose body mass index is over 30 should also include a referral to an intensive weight-loss program that involve dietitians, lifestyle coaches and psychologists.

Research has convinced the USPSTF about the effectiveness of intensive weight loss programs lasting between one and two years. These programs use different strategies for behavior change, but most promoted self-monitoring of weight among patients with tools to maintain weight loss, like scales, pedometers, or exercise videos as well as counseling.

Primary care physicians can get training in nutrition, exercise, and motivational interviewing which could improve delivery of obesity care and weight loss counseling. In the longer term, changes to medical curricula to include the integration of multidisciplinary education or ‘collaborative care’ models can help.

In the face of time and resource pressures, many physicians may find it challenging to deliver intensive behavioral weight loss interventions supported by the best scientific evidence.

As clinicians focus on improving conversations about weight and health,

outsourced medical transcription services are a great option when it comes to saving time, meeting documentation demands, and maintaining work-life balance.

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