Clinical Encounters: Obesity

Skills Training for Primary Care Providers

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Roles and Challenges for Medical Providers in Treating Obesity

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Continuing our look at the obesity epidemic, let’s focus on the roles and challenges for medical providers who are treating obesity in their patients.

Roles

Evidence-based practice guidelines recommend that medical providers screen all of their patients for weight problems. They use this information to diagnose the extent of excess body mass as overweight or obese (Bays et al., 2016-2017; Garvey et al. 2016). Assessing for excess abdominal body fat is also important because it correlates with even more risk of adverse health consequences of excess body fat.

Guidelines also recommend comprehensive treatment for patients who are overweight or obese and who have weight-related adverse effects. The treatments should include:

  • a reduced energy diet
  • increased physical activity for all patients
  • behavioral supports for at least 6 months

Challenges Faced

Primary care providers can be an important and effective source of the behavioral support that patients need for weight loss (Rueda-Clausen et al., 2014; Wadden et al., 2014; USPSTF, 2012). However, the rate of weight-loss counseling in primary care is low (Antognoli et al., 2015; Sinclair et al., 2008; Brauer et al., 2012). Reasons that clinicians report for their low rate of weight-loss counseling include inadequate training and low confidence in their ability to counsel patients in weight -related topics (Howe et al., 2010; Mogre et al., 2017).

Despite these recommendations, primary care physicians and other primary care clinicians do not consistently assess, diagnose, counsel, or advise patients who are overweight or obese. For example, in an analysis of patient visits where the patient was overweight or obese, only:

  • 50% discussed weight at all
  • 38-47% of those discussions included at least one of the evidence-based guidelines at that time
  • 35% of the discussions included an assessment and treatment strategy related to weight

(Antognole et al., 2014)

A study of over 32,000 patient visits found that physician weight counseling, including counseling on diet and exercise, decreased from 1995-1996 to 2007-2008 despite an increase in incidence of overweight and obesity (Kraschnewski et al., 2013). The decrease was greatest in patients having the adverse health consequences of hypertension and diabetes. One possible reason is a decrease in the length of time spent with patients due to restructuring of medical practice and an increase in time spent in documentation in the electronic health record.

Additionally, physicians frequently report a lack of training and competence in weight assessment and management (Dietz et al., 2015; Smith et al., 2015). Furthermore, 80% of providers surveyed reported that they need additional training in classifying obesity for the purpose of determining need for surgical interventions and 88% of these providers reported needing further training in the use of pharmacotherapy in weight management.

The bottom line is that primary care providers could play an important role in addressing weight management in their patients but face realistic challenges. The first, the structure of modern practice, may be more difficult for the individual provider to change. However, the other two challenges, insufficient training and the need to think of obesity as a chronic illness are within reach.

References

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Bradley Tanner

Bradley Tanner, MD, ME is a psychiatrist and Studio Head of HealthImpact.studio. In this role, he guides the development and evaluation of novel technological solutions to address health challenges including burnout, stress, and depression seen in medical students, residents, and practicing physicians in their early and later careers. You can reach Dr. Tanner at bradtanner@gmail.com. Personal health concerns and concerns related to suicidality should be addressed with your health professional.

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