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March 21, 2019

Obesity Treatment, Beyond the Guidelines: Practical Suggestions for Clinical Practice

Author Affiliations
  • 1Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Washington, DC
  • 2National Center for Weight and Wellness, Washington, DC
  • 3Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
  • 4Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
JAMA. 2019;321(14):1349-1350. doi:10.1001/jama.2019.2352

Counseling patients about weight management may be one of the most challenging aspects of primary care. Clinicians widely perceive that they have a responsibility to address obesity, although this has not generally translated to clinical practice. According to a study of 1500 health care practitioners, 97% responded that they have a responsibility to ensure that patients are counseled about obesity.1 In another study of 606 clinicians, 96% “agree” or “somewhat agree” that they should contribute to patients’ weight management, 88% acknowledged that moderate weight loss is “extremely beneficial” for patients with obesity, and 80% recognized obesity as a disease.2

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    4 Comments for this article
    Thank you
    Jessica Inwood, MD, Diplomate of the ABOM | Southcoast Health
    Thank you, Dr.Kahan, for your dedication to raising awareness of the scope of the obesity epidemic, the impact obesity has on patients, and the difference the medical community can make in patients’ management of this chronic disease. I particularly appreciated your statement regarding the lack of evidence that there is a “best diet.” Everyone agrees that reducing processed foods and reducing sugars are essential parts of improving the quality of a diet. I wish proponents of particular diets, whether it be Mediterranean, plant-based, LCHF, etc., could respect the idea that there may be more than one path to a healthier weight. We urgently need quality, unbiased research showing the benefits of these lifestyles. Keep fighting the good fight!
    Physician Board Certification in Obesity Medicine
    Rekha Babu Kumar, M.S., M.D. | Weill Cornell Medicine/New York Presbyterian Hospital
    Thank you for updating the physician community on our progress in the area of clinical treatment of obesity. As you point out, physicians do feel that it is their professional responsibility to address diet, nutrition, and body weight with patients, yet this is only being done a small percentage of the time. Some of the reasons you cite for this discrepancy are lack of obesity medicine education, limited time during office visits, and lack of insurance reimbursement for obesity care. As a busy endocrinologist in clinical practice, I agree with all those reasons. The fact that physicians are rarely coding for obesity when the disease is present and not providing CMS covered “Intensive Behavioral Therapy (IBT)” despite the increasing prevalence of the disease leads me to focus on the topic of physician education on the topic of obesity treatment. Physicians need to feel confident when counseling patients on a topic where the science and clinical guidelines are relatively new. The establishment of the American Board of Obesity Medicine (ABOM) and the opportunity physicians have to become certified in the field of obesity medicine through the ABOM process is a way physicians can garner competency in obesity treatment. Obtaining ABOM certification and completing the required continuing medical education on the topic of obesity may empower the physician to discuss obesity and nutrition once he/she feels they are prepared and qualified to discuss this sensitive topic. For young physicians who want to focus their career on the disease of obesity, there will be more opportunities to be trained in this field through the creation of obesity medicine fellowship programs through the Obesity Medicine Fellowship Council (OMFC). My hope as the medical director of the ABOM is that more physicians choose to become certified to help move clinical treatment of obesity forward.
    CONFLICT OF INTEREST: Medical Director, American Board of Obesity Medicine
    Treating & Advocating for patients affected by obesity
    Walter Lindstrom, J.D. - Patient Advocate | Lindstrom Obesity Advocacy - USA
    Thanks to Drs. Kahan and Manson for continued support of patients struggling with the disease of obesity and its related co-morbid conditions. Your ABCDEF approach is an excellent practical reference which I hope is embraced by all physicians and other health care providers. Your point about improvements in coverage and payment for related services is well-taken and having worked for 25 years fighting for patients suffering with obesity I agree it's getting better. Still, the starting point was near Zero so there really was nowhere to go but up. There are too many practitioners who allow payers to "drive the bus" when it comes to treatment; I hope implementing your ABCDEF approach won't be stymied by payers placing unreasonable, clinically incoherent barriers which range from virtually no coverage to insufficiently reimbursing services which are absolutely medically necessary to appropriately treat persons affected by obesity. But it won't matter unless the community accepts the fundamental proposition that patients like myself - deeply affected by obesity - are deserving of compassion, respect, encouragement and attention. Too many times people report to me that they are shunned, blamed and shamed by their doctors or nurses or dieticians claiming to "help" and so hopefully the "A" [Ask] will be done the right way so people affected by the disease can know they are in a safe place. Thanks for providing an important Viewpoint.
    Left Out: Experts in Behavioral Management
    Diana Joy, MA Counseling Psychology | Welcome Counseling and Education Services
    I am sad to see that no mention is made in resources or the body of the article of the health-care professionals who are experts at helping clients develop successful behavior change plans and maintain behavior changes, the community of behavioral health professionals. This includes Licensed Professional Counselors, Licensed Social Workers, Psychologists and others licensed primarily for behavioral/mental health treatment.

    Food and weight are emotional issues also. Whether or not emotion plays a role in obesity, it plays a significant role in how an individual addresses their weight and health. When interventions for depression, anxiety, or insomnia are not
    part of the treatment program, clients are set up for failure.

    At times like this I wonder if I just imagined the movement to integrate behavioral and physical health services.

    Diana Joy, LPC