According to recent studies, intensive behavioral counseling works for clinically meaningful weight loss. However it is rarely delivered by primary care doctors, researchers reported. With more than two-thirds of adults in the U.S. overweight or obese, doctors are desperate to find ways to help people lose weight.
In a meta-analysis, patients who had counselling, achieved a maximum weight loss of about 14 lbs, compared with a top loss of about 4 lbs for those who did not participate in such programs, reported Thomas A. Wadden, PhD of the University of Pennsylvania in Philadelphia, director of Penn’s Center for Weight and Eating Disorders and the review’s lead author.
But research on how primary care practitioners can best provide behavioral weight loss counseling to obese patients in their practices, as previously encouraged by the Centers for Medicare and Medicaid Services (CMS), remains insignificant, according to a systematic review of this topic published today in JAMA. “After an exhaustive search, we found only 12 high quality randomized controlled trials that examined the behavioral treatment of obesity in patients encountered in primary care settings,” said Thomas A. Wadden. “Of those, only two studies identified counseling interventions that produced an average loss of at least five percent of initial body weight, an amount likely to improve weight-related health complications.”
The researchers began their review as a consequence of two important policy developments in weight management. In 2003 and in 2012, the U.S. Preventive Services Task Force recommended that primary care practitioners screen all adults for obesity and offer or refer affected individuals to an intensive, multicomponent weight loss intervention.
Moreover in 2011, CMS approved payment for intensive behavioral weight loss counseling, consisting of approximately 14 face-to-face, 10 to 15 minute sessions over six months, for obese individuals treated in primary care settings. “The CMS’s decision to reimburse the cost of intensive behavioural counselling for Medicare-eligible patients was an important step in advancing the treatment of a disease that has long been overlooked,” said Adam Tsai, MD, a co-author of the review and an internal medicine and obesity specialist at Kaiser Permanente in Denver.
However, the researchers did not find any studies in which primary care practitioners delivered behavioral counseling following the exact CMS guidelines.