Doctors Urged to Help Patients Lose Weight
Dec 8, 2003 -- Battling the bulge? Your doctor may soon become more involved with helping you lose weight, following the issuance of new guidelines for treating obese patients.
The U.S. Preventive Services Task Force, an independent government-sponsored panel of primary care doctors and prevention experts, now recommends clinicians screen all adult patients for obesity during their regular checkups, and that primary care doctors provide obese patients with diet assistance or refer them to other weight specialists.
The task force, whose findings were published in the Dec. 2 issue of the Annals of Internal Medicine, suggests the Body Mass Index, or BMI, is a reliable screening test for obesity.
BMI can be calculated as weight in pounds divided by height in inches squared multiplied by 703, but most doctors have a portable table that helps them figure the number easily. Anyone with a BMI greater that 30 is considered obese. The Centers for Disease Control and Prevention has an online BMI calculator at http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.
Dr. Michael Fleming, president of the American Academy of Family Physicians, says the recommendations are potentially "very effective and practical."
"To not do this is to not care about the onset of diabetes, heart disease, etc.," he said. "I think that all family physicians will resonate with this recommendation. I also believe that family physicians will do this — simply because they know it is the right thing to do for our patients."
Who’s Got Time, and Who’s Going to Pay?
Yet while doctors overwhelmingly agree weight loss deserves attention, many may struggle with the time and financial constraints of working more closely with overweight patients.
For instance, physicians are concerned many insurance companies will not routinely pay for doctor's visits that are primarily for obesity counseling, leaving patients paying out-of-pocket for these appointments.
"A large proportion of patients have basic acute medical care and hospitalization coverage, and even high-end HMOs only cover weight-loss counseling when there is a primary chronic disease to which obesity is a major contributor, such as diabetes," said Dr. Thomas Schwenk, a family physician at the University of Michigan in Ann Arbor. "Primary prevention is almost nonexistent as a covered benefit, and primary care physicians certainly do not have the resources in-office."
But Dr. Richard Roberts, a family physician at the University of Wisconsin Medical School who provides some individualized obesity counseling to his patients with the help of a nurse and dietitian, says he has had more success than many of his colleagues with reimbursement from insurance companies and believes some patients will sacrifice to pay if needed.
"Most of the time, the issue of obesity can be raised and medically managed through the usual health insurance coverage. Things get a bit trickier when one attempts more nontraditional approaches like group visits. The highly motivated person will usually find a way around the financial barriers," said Roberts.
Hoping for Change
Still, many physicians hope insurance companies and Medicare will take the task force recommendations to heart and upgrade their reimbursement to physicians.
One of those people is Dr. Christine Laine, senior deputy editor of the journal that published the task force recommendations.
"Unfortunately, the degree of counseling that a primary care doctor can offer in the setting of a visit is limited and falls far short of the types of interventions that the [task force] found to be effective," she said. "Most insurance does not cover the types of weight loss counseling interventions shown to be effective."
The intensive counseling to which Laine refers includes two or more individual or group diet and exercise counseling sessions per month for at least three months. Such counseling should be combined with behavioral interventions to help patients develop skills, motivation and support systems to help them lose weight. Long-term maintenance interventions should also be done to help sustain weight loss.
But Laine hopes the task force recommendations will give patients and doctors the opportunity for more options in weight management.
"There are few available options of places where doctors can refer patients for the sort of intervention the [task force] recommends," she said. "My hope is that release of these recommendations will make insurers realize that they should cover such weight-loss counseling and interventions."