My husband is a doctor in the trenches, seeing patients in the hospital and in his office as a private practitioner and hospitalist. His patients tend to be complicated, with multiple ongoing health conditions. Not surprisingly, many of them have weight issues. We often chat about the challenges he faces dealing with this type of patient populace. When it comes to our discussions about counseling his patients regarding their size, we do not chat - we battle.
I ask him if he takes the opportunity to discuss weight modification with patients. He says it depends on the patient. I reply that every overweight or obese patient needs to, at minimum, be engaged in a discussion about weight, especially since many of their ongoing health complaints directly connect to their excess weight. He says it's not a discussion that is welcome, and unless the patient brings it up, or he feels that the patient is open to a talk on weight, he does not engage on that issue. He says that issue with italics around it - I hear it in his voice. Being a nutritionist and knowing how obesity trends are sweeping the nation and the world, this is obviously very troubling to me. He feels that the weight discussion can "anger, embarrass, undermine, hurt, offend" the patient. I say, if you can't talk to your doctor about your weight, then who can you (or will you) talk to?
A new USPSTF (U.S. Preventive Services Task Force) recommendation was recently released advising that adult patients receive an intense, comprehensive and multi-level behavioral intervention if they are obese. The recommendation was an update of the 2003 task force guidelines for obesity screening. The intent is to nudge doctors to talk with their patients and help them to set up individual and/or group weight management sessions. Goal setting for weight loss, improved fitness efforts, and strategizing to remove self-imposed barriers to weight loss are recommended key elements. Sounds like a lofty undertaking, but it was actually based on the review of close to 40 studies involving behavioral interventions, 10 studies involving behavioral intervention plus an obesity medication (Orlistat), and 3 studies involving behavioral modification plus the diabetes drug metformin.
All groups lost weight, but researchers noted that the greater the number of behavioral interventions, the more weight lost by participants. There were other positive and negative outcomes, but the core observation was this successful weight loss as it related to ongoing behavioral interventions. Screening for obesity by doctors makes sense. Counseling and education should be performed by dietitians and nutritionists, in coordination with a doctor dispensing medication or other support when appropriate. Psychological counseling should also be a possible component of therapy and follow up for some patients. In fact, a team approach to obesity treatment that is ongoing, may have more effective outcomes.
I think doctors like my husband would welcome weight screenings that are affordable and covered by insurance, and treatment that is meaningful, ongoing, and that takes into account the personal differences among patients. Healthcare needs to cover a multi-disciplinary approach to the obese patient and it needs to adjust to the patient's needs and therapeutic goals. As a doctor, my husband knows that the road to weight loss and keeping the weight off is complicated and protracted and requires more time than he alone has to give. What do you think?
Published On: August 05, 2012