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Counseling scarce for overweight patients

PENN STATE (US) — Despite a rise in obesity, fewer doctors are offering weight counseling to their patients, new research shows.

The findings are especially true for patients with high blood pressure and diabetes, according to the study, published in the journal Medical Care.

Researchers analyzed data from the National Ambulatory Medical Care Survey for the years 1995-1996 and 2007-2008. The national survey collects information about the provision and use of outpatient medical care services in the United States. The 2007-08 data was the most recent available at the time of the study, and the two time periods were chosen because the survey structure was similar for better comparisons.

More than 145 million adult Americans are overweight or obese. Despite the current obesity epidemic, patients seen in 2007-2008 had 46 percent lower odds of receiving weight counseling, with counseling occurring in only 6.2 percent of visits in that year. At the same time, the percentage of adults who were overweight or obese increased from 52.1 percent in 1995 to 63.3 percent in 2008.

“It is striking that the odds of weight loss counseling declined by 41 percent, with only 29.9 percent of obese patients receiving counseling in 2007-2008, given the substantial increases in the rates of overweight and obesity during that time,” says Jennifer Kraschnewski, assistant professor of medicine at Penn State.

Patients with high blood pressure were 46 percent less likely to receive counseling, and diabetes patients were 59 percent less likely. “People with these conditions stand the most to gain from the weight counseling,” Kraschnewski says.

In 2003, the US Preventive Services Task Force recommended that physicians screen all patients for obesity and offer counseling and interventions to promote sustained weight loss. Created in 1984, the task force makes evidence-based recommendations about preventive services including screenings and counseling.

“Unfortunately, other studies have shown that physicians do not conduct weight and weight-related counseling for the majority of their affected patients,” Kraschnewski says. Evidence shows that counseling can help adults lose weight and keep it off.

The reasons for this drop are unclear, but doctors may be pessimistic that patients can change, have limited time during appointments, and believe their training for lifestyle counseling is inadequate.

“There are many additional competing demands in the outpatient care between study years, including an increase in chronic illnesses, a focus on quality improvement, and use of electronic health records,” Kraschnewski says. “Although visit duration has actually increased over the study time period, the number of items addressed during clinic visits has increased substantially more, suggesting less time is available to provide counseling.”

Other reasons may be that counseling services are not reimbursed, the researchers say, or that as physicians see rising rates of obesity among their patients, they offer less counseling because of a perceived lack of success.

The lack of response to the obesity epidemic by primary care providers is a missed opportunity, Kraschnewski says.

“Primary care has long been instrumental in significant public health successes such as decreased stroke and heart disease deaths due to the management of high blood pressure and high cholesterol. However, unlike these conditions, primary care providers lack effective tools to address the obesity epidemic.”

Effective and easily implemented interventions to address weight counseling in the primary care setting are needed, she says..

“PCPs serve on the frontlines of health care and must be actively engaged to help address the nation’s obesity epidemic.”

Researchers from the University of Texas Medical School contributed to the study.

Source: Penn State

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  1. Pam Peeke, MD

    Recent polls have shown that there is almost no training in medical schools for treating overweight and obesity, and that doctors have, in general, a prejudice against such patients. This is ironic when we consider that 1/3 our of our patients are obese.

    Further, obesity is often a result of addiction, known as Binge Eating Disorder. According to the Binge Eating Disorder Association (2011), this problem affects more than eight million men and women and accounts for three times the number of those diagnosed with anorexia and bulimia together.

    Coaching and counseling are among the most affective ways of treating this disease because it can take into account the individual’s sense of alienation, secretiveness and lack of information. And there are no ifs ands or buts on the subject of food addiction: it is as real as cocaine or alcohol addiction and, in fact, affects exactly the same pleasure/impulse control centers of the brain as recognized drugs. This is especially true of what David Kessler calls hyperpalatable foods — foods dense in calories from sugar/fat/salt. Oxford University Press has just published the medical textbook on the subject: Food and Addiction: A Comprehensive Handbook, edited by Kelly D. Brownwell & Mark S. Gold. And I’ve just published the first holistic approach to food addiction, The Hunger Fix, which is based on that cutting edge science.

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