Evidence-based guidelines recommend that providers use motivational interviewing techniques as a tool for encouraging behavior change when managing and preventing obesity in adults (Fitch et al., 2013). Studies suggest that training in motivational interviewing skills will benefit physicians in helping their patients lose weight (Barnes & Ivezaj, 2015). Use of motivational interviewing by physicians with obese patients in clinical trials was associated with a reduction in body mass, body weight, BMI (Armstrong et al., 2011).
Despite these recommendations and findings, primary care physicians do not consistently counsel or advise patients who are overweight or obese (Smith et al., 2011). Barriers to providing motivational counseling for weight management in primary care include time constraints/too high a workload, lack of experience or training, lack of access to trained weight loss interventionists, and patients’ financial limitations with respect to being able to afford a weight loss clinic(Barnes & Ivezaj, 2015).
In our needs analysis survey (N=25), 96% of providers felt they needed the training to counsel patients on weight control based on best practice recommendations. Only 35% of providers acknowledged using motivational interviewing techniques with overweight or obese patients, while 92% of providers acknowledged a need for additional training using counseling or motivational interviewing (Tanner, 2011).
Evidence-based guidelines also recommend for overweight and obese individuals who would benefit from weight loss, that providers prescribe a calorie-restricted diet, increased physical activity, and (for most of these patients) participation for ≥ 6 months in a comprehensive lifestyle program that assists participants in adhering to these lifestyle changes through the use of behavioral strategies (Jensen et al., 2013).
Guidelines further recommend an algorithm that responds to the patients’ readiness to start a weight-loss program. In our survey of obesity experts (N=7), 71% believe that primary care providers need additional training in interviewing patients regarding current diet and level of physical activity (Tanner, 2011). Furthermore, evidence-based guidelines recommend long-term follow-up of patients during and after a weight-loss program, with an intensive program including continued reduced caloric intake, recommended levels of physical activity or higher, and behavioral supports (Jensen et al., 2013). However, of the primary care providers we surveyed, (N=25) only 40% monitored their patients’ during weight loss, while only 32% monitored patients after weight loss.
And evidence-based guidelines recommend that providers prescribe a calorie-restricted diet for obese and overweight individuals who would benefit from weight loss, based on the patient’s preferences and health status, and in most instances, behavioral supports in the form of weight-loss programs or trained interventionists for counseling (Jensen et al., 2013).
However, physicians frequently report a lack of training and competence in weight management in general (Dietz et al., 2015; Sabin, Marini, & Nosek, 2012; STOP Obesity Alliance, 2010). More specifically, both obesity experts and primary care providers in our needs analysis surveys reported a gap in provider training on recommending diets. In our survey of obesity experts, (N=7), 86% believed that primary care providers need more training in what diet to recommend to patients. In our needs analysis, 84% of the primary care providers surveyed reported that they needed training to counsel patients on proper diet recommendations (Tanner, 2011).
Practice Gap References
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Armstrong, M. J., Mottershead, T. A., Ronksley, P. E., Sigal, R. J., Campbell, T. S., & Hemmelgarn, B. R. (2011). Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 12(9), 709–723. https://doi.org/10.1111/j.1467-789X.2011.00892.x
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Barnes, R. D., & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 16(4), 304–318. https://doi.org/10.1111/obr.12264
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Dietz, W., Baur, L., Hall, K., Puhl, R., Taveras, E., Uauy, R., & Kopelman, P. (2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet. http://dx.doi.org/10.1016/S0140-6736(14)61748-7
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Fitch, A., Everling, L., Goldberg, J., Heim, C., Johnson, K., Kennedy, E., … Webb, B. (2013, May). Health Care Guideline: Prevention and Management of Obesity for Adults. Retrieved April 8, 2019, from Institute for Clinical Systems Improvement website: https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/cntrb_037112.pdf
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Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 01.cir.0000437739.71477.ee. https://doi.org/10.1161/01.cir.0000437739.71477.ee
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Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLOS ONE, 7(11), e48448. https://doi.org/10.1371/journal.pone.0048448
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Smith, A. W., Borowski, L. A., Liu, B., Galuska, D. A., Signore, C., Klabunde, C., … Ballard-Barbash, R. (2011). U.S. primary care physicians’ diet-, physical activity-, and weight-related care of adult patients. American Journal of Preventive Medicine, 41(1), 33–42. https://doi.org/10.1016/j.amepre.2011.03.017
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STOP Obesity Alliance. (2010). Provider/Patient Survey on Obesity in the Primary Care Setting. STOP Obesity Alliance. Retrieved from http://www.stopobesityalliance.org/research-and-policy/research-center/survey-results/
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Tanner, B. (2011). Improving Obesity Outcomes Through Interactive Web-Based Clinical Skills Training | SBIR.gov. Retrieved April 3, 2019, from https://www.sbir.gov/sbirsearch/detail/389149
