Behavioral Therapy for Weight Loss May Benefit Most Americans

My Bariatric Life Health Guide
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    Behavioral Therapy as a Resource to Help Address Obesity

    After rolling out the Obesity Guidelines and recommendations to such questions as who needs to lose weight, how much weight needs to be lost to improve health, and what are the best methods for weight loss to follow, these questions and recommendations were applied to the United States population. The less than startling conclusion was that a fantastic number of people are in need of weight-loss treatment. 

    Data from the National Health and Nutrition Examination Survey (NHANES) was used to discover how many people were recommended to lose weight among adults who were twenty years old or more and not pregnant. Recommendations were based on weight, height, waist circumference, and risk factors such as hypertension and diabetes. 

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    The results were that 65 percent of American adults were considered for behavioral weight loss treatment, and 83 percent - 116 million - of those were considered for pharmacotherapy. Thirty-two million adults were recommended for both behavioral weight-loss treatment and pharmacotherapy as well as potential candidates for bariatric surgery.

    Those most likely to be recommended for treatment were African American or Mexican American, over the age of 45, male, without a college degree, and insured by Medicaid or Medicare. 

    In a nutshell, people are in need of help and there are evidence-based treatments available for most adults who would be recommended for weight-loss treatment. Among the options is behavioral weight-loss treatment.

    If Only It Was That Easy

    While behavioral counseling is a recommended addition, and can be effective, research on how primary care doctors can best provide weight loss counseling to patients in need does not paint a rose-colored picture.  

    Researchers found only 12 quality trials that examined the behavioral treatment of obesity in patients in primary care settings. Only two of those studies showed counseling interventions that produced at least a five percent average loss of initial body weight. In 2011, the Centers for Medicare and Medicaid Services (CMS) approved funding for intensive behavioral weight-loss counseling. Counseling would consist of 14 face-to-face sessions of 10 to 15 minutes over a period of six months for obese patients in primary care settings. Unfortunately, researchers could not find any studies that showed primary care practitioners providing behavioral counseling that followed the exact CMS guidelines. 

    One of the guidelines is that counseling can only be provided by those practitioners defined by the CMS. Such counselors are limited to physicians, nurse practitioners, clinical nurse specialists and physician assistants. Counseling may be provided by auxiliary health professionals who work in the same setting as the primary care practitioners and who are under their direct supervision. The problem is that no studies meeting this criteria were discovered in the review.   


    Researchers concluded that primary care practitioners could learn to provide intensive behavioral counseling, but because of the demand for their time it would probably be most useful if patients were referred for behavioral weight loss counseling. Some also believe that telephone-delivered counseling from the patient’s primary care practice or from a disease management call center is tied to the future.     


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    Up next: Behavioral Treatment for Obesity: What's It Like?

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Published On: November 18, 2014