Doctors should send obese patients to dietary advice, according to a panel. But many do not: salt: NPR

If patients are obese, their doctors should refer them to behavior-based weight loss programs or suggest theirs, according to a national panel of experts. Yet many doctors do not have the necessary conversations with their patients.

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If patients are obese, their doctors should refer them to behavior-based weight loss programs or suggest theirs, according to a national panel of experts. Yet many doctors do not have the necessary conversations with their patients.

Tetra Images / Getty Images

A visit to your GP can focus on your painful headaches or back pain. However, according to a panel of national experts, if your body mass index is greater than 30, it should also include an intensive weight loss program.

This is the latest recommendation of the US Task Force on Preventive Services, an independent group of national experts in diseases and public health, which advises primary care physicians on best practices. The group published a review of the evidence and the recommendation in the Journal of the American Medical Association Tuesday.

The recommendation is identical to that of 2012, with some major differences. The first is the proof: with 83 new studies published since the last recommendation, the panel is even more convinced that intensive weight loss programs – lasting between one and two years – work.

What is "intensive"? Most of the programs studied lasted between one and two years and focused on modifying food intake and physical activity. Although programs have used different behavior change strategies, most have encouraged patients to monitor their own weight and have provided tools to help maintain weight loss, such as scales, pedometers, or videos. # 39; exercise. The board was part of most programs and most had 12 or more sessions in the first year.

Since 2012, the panel has also evaluated the five drugs approved by the Food and Drug Administration for the long-term management of obesity. In combination with behavior-based programs, the panel concluded that drugs are more effective than program participation alone, at least for 12 to 18 months. But the panel also noted that some of the drugs have undesirable side effects and that there is little research data on weight loss drugs and their long-term effectiveness.

The group's main recommendation remains the same: if patients are obese, their doctors should refer them to behavior-based weight loss programs or offer theirs.

Sounds simple, right? This is not exactly what says Chyke Doubeni, a primary care physician at the University of Pennsylvania and a professor of family medicine and community health at the USPSTF.

The Affordable Care Act requires that insurance providers cover all recommended preventive services.

But "the evidence suggests that primary care physicians do not talk about obesity to their patients and do not offer them services that could help lose weight and maintain their fitness," Doubeni told Allison. Aubrey.

Ashley Mason, a behavioral psychologist at the University of California, San Francisco's Biology and Experience of Eating Lab, explains that the reason could be the weather. "These 14-minute visits with your [primary care physician] do not have enough time for everything, "she says. And every time a patient leaves his office without a plan to fight obesity, he remains at risk for developing negative health problems like diabetes and hypertension.

For Debra Haire-Joshu, who heads the Center for Prevention of Obesity and Policy Research at the University of Washington in St. Louis, the challenge is to put the recommendations into practice. In an editorial published simultaneously in JAMA Internal Medicineshe argues that the recommendations do not necessarily reflect how primary care physicians practice medicine.

Primary care physicians should not have the impression of having to go it alone to counsel obese patients, she says. Instead, they should refer these patients to other members of the health community, such as dietitians, coaches and psychologists.

"We know what works," says Haire-Joshu. "Now we have to find a way to provide something better than what we are doing right now."