Office Visit Weight-loss Counseling
Abstract & commentary
By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.
Synopsis: A survey of U.S. primary care physicians found that although most recommend weight loss to their obese patients, they do not utilize current evidence-based recommendations, and they underestimate the therapeutic effects of small weight losses.
Source: Phelan S, et al. What do physicians recommend to their overweight and obese patients? J Am Board Fam Med 2009;22:115-122.
Self-reported data from family physicians and internists clustered around a Rhode Island hospital were analyzed to determine what behavioral interventions for weight loss were given in a typical office visit, as well as the basis for those recommendations and their expectations for beneficial results. More than 75% stated they addressed obesity and weight-loss strategies routinely. From 101 responses (54% of those surveyed), the most likely recommendations were increasing physical activity, reducing consumption of fast foods, reducing portion sizes, and reducing soda consumption. They were less likely to recommended regular self-weighing, recording food intake, and decreasing television viewing, and rarely advised the use of meal replacements, commercial or internet resources, or weight-loss medications.
Weight-loss recommendations were based more on clinical experience than scientific literature, with more exercise recommended by those who were the most physically active themselves. Female physicians were more likely to refer for nutritional counseling, and variety was also seen in which diets different types of physicians recommended. Most physicians hoped for a weight loss of at least 20% for a beneficial result; one-third characterized a weight loss between 5% and 10% as a "disappointment," although 10% of the doctors rated it an "acceptable" outcome.
Commentary
Physicians in this study did appropriately recommend weight loss for most obese patients, but they need more help on which strategies to promote. An increasing amount of scientific studies tell us that "diet and exercise" may not be enough for success, and national recommendations have been compiled to guide us.1 Although physicians rarely recommended commercial weight-loss programs, meal replacements, internet programs, recording food intake, decreasing television viewing, or self-monitoring of weight, all of these strategies do have evidence to support their benefits.2
Targeting fast foods, portion sizes, and soft drink consumption is the correct first step, since these are the most common current factors in our obesity epidemic.3 For success, however, the next step should include a variety of different strategies tailored to the patient, including consideration of weight-loss medications and referral to dietitians and other support programs. In contrast to what most study physicians thought, a weight loss of just 5-10% has actually been demonstrated to yield significant health benefits, so even a few pounds of weight loss should be encouraged and congratulated.
References
1. McTigue KM, et al. Screening and interventions for obesity in adults: Summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003;139:933-949.
2. Harvey EL, et al. An updated systematic review of interventions to improve health professionals' management of obesity. Obes Rev 2002;3:45-55.
3. Hill JO, et. al. Genetic and environmental contributions to obesity. Med Clin North Am 2000;84:333-346.
A survey of U.S. primary care physicians found that although most recommend weight loss to their obese patients, they do not utilize current evidence-based recommendations, and they underestimate the therapeutic effects of small weight losses.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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