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. Behavioral weight loss counseling often works, but some Philadelphia-area researchers argue that the job should go to a broader range of health care providers.
Three years ago, the federal government agreed to reimburse primary care providers, including physicians, nurse specialists or practitioners, and physician assistants for counseling sessions designed to help Medicare and Medicaid patients lose weight.
To find out how effective that counseling might be, Penn's Center for Weight and Eating Disorders director Thomas Wadden said his team scoured the medical literature. After reviewing more than 3,000 abstracts, they couldn't find a single study evaluating counseling provided by those primary care providers and meeting the Centers for Medicare and Medicaid Services guidelines.
"There's a good reason that we couldn't find any studies," Wadden said. "Primary care practitioners are among the busiest people in the world, taking care of just so many different health problems that they encounter each day. So I really don't think that they have time to meet weekly or every other week to provide weight loss counseling."
Publishing today in the journal JAMA, the team did, however, find studies where other specialists successfully helped patients shed some pounds.
"Overweight and obese adults should feel very encouraged that if they participate in a high-quality behavioral treatment program that they're likely to lose enough weight to have a meaningful impact on their health," said co-author Meghan Butryn, a Drexel psychologist.
The most effective programs, she said, combined diet and exercise with behavioral skills to keep people on target.
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For example, in one reviewed study, a registered dietitian and fitness instructor led 65 percent of participants to lose 5 percent or more of their initial body weight after six months.
"Weight loss of that magnitude goes a long ways in preventing the onset of Type 2 diabetes," said Wadden. "It can also help to ameliorate sleep apnea, blood pressure, and it improves quality of life."
But with so few physicians offering the services, Wadden and Butryn said reimbursements should be extended to other trained health professionals who can provide counseling at lower cost. And while face-to-face counseling is the current standard, Wadden noted that one study found telephone counseling just as effective.
"I think we're going to see an increasing use of call centers in disease-management programs," he said. "You potentially will be talking on the phone in Philadelphia with someone who is in Iowa, helping you with your weight control."
