Physicians can have an influence on their overweight and obese patients by counseling them to prevent further weight gain and by helping patients to have a more realistic perception of their weight, which may lead to behavioral changes, according to two reports in the February 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.1
In background information in the articles, the authors comment that the increasing prevalence of overweight and obesity is now a worldwide problem that is associated with higher risk of death, and the development of certain cardiovascular diseases, type 2 diabetes and some cancers. “Studies show that lifestyle intervention (including a nutrition and physical activity component) are needed to maintain or lose weight,” the authors note. “The primary care setting is suitable for weight maintenance; previous studies have shown that lifestyle interventions in primary care can be effective, at least in the short term.”
Nancy C.W. ter Bogt, M.Sc., from the University Medical Center Groningen, the Netherlands, and colleagues, examined the results of a long-term, 3-year study on lifestyle counseling by nurse practitioners compared with general practitioners and usual care in overweight and obese patients in preventing weight gain and improving health status. The 457 study participants, average age 56 years and 52 percent female, were randomized into two groups. The 225 patients in the nurse practitioner group received lifestyle counseling using a standardized program of individual visits and feedback sessions by telephone. The remaining 232 patients were in the general practitioner usual care group. All patients had medical examinations that included measurements of body weight, length, waist circumference and blood pressure. The measurements were performed at baseline (between January and July 2006), after one and three years.
“In both groups, approximately 60 percent of the participants achieved weight maintenance after three years,” the authors report. There was no significant difference in the average weight change and change of waist circumference between the two groups. There was a significant difference in the impaired fasting glucose level between the two groups: 6 percent in the nurse practitioner group vs. 12 percent in the general practitioner usual care group. But, there were no significant differences for lipid levels and blood pressure readings.
In conclusion the authors write: “Lifestyle counseling by nurse practitioners did not lead to significantly better prevention of weight gain compared with general practitioners. In the majority in both groups, lifestyle counseling succeeded in preventing (further) weight gain.”
In an accompanying invited commentary, Debra Haire-Joshu, Ph.D. and Samuel Klein, M.D., from Washington University School of Medicine, St. Louis, write that “the primary care provider is a critical entry point to the health care setting for the obese population.” 2
“Weight loss interventions in primary care settings will be more effective if coordinated care is reimbursed and more sustainable if supported by complementary actions of multiple settings, such as worksite or community.”
In another article in this issue of Archives, Robert E. Post, M.D., M.S., from the Medical University of South Carolina, Charleston, analyzed data from the 2005 – 2008 National Health and Nutrition Examination Survey (NHANES) on adults ages 20 to 64 years with a body mass index (BMI) of at least 25 3. The researchers were evaluating patient perceptions of overweight and obesity. And they also examined reports of physician acknowledgement of patients’ weight status and whether that was associated with a difference in perceptions and behaviors, such as desire or attempts to lose weight.
“In participants with BMIs of 25 or greater, 45.2 percent reported that they had been told by their physician that they were overweight. In participants with BMIs of 30 or greater, 66.4 percent reported that they had been told by their physician that they were overweight,” the authors write. “Telling an overweight patient that they are overweight was associated with a greater than eight-fold increase in the odds that the patient will classify themselves as overweight compared with a patient who has not been told they are overweight. For those who are obese, there was more than a six-fold increase.” In addition, having been told that they were overweight or obese, resulted in the participants having a greater desire to lose weight and, for some, attempting to lose weight.
“In conclusion3, patient reports of being told by a physician that one is overweight were associated with major increases in the odds that overweight and obese participants had realistic perceptions of their own weight, had a desire to lose weight, and had made recent attempts to lose weight. However, fewer than one-half of overweight and fewer than two-thirds of obese participants had been told by their physicians that they are overweight. This is an important intervention point that is being missed by many physicians. Physicians need to tell more overweight and obese patients that they are overweight because this may help encourage them to change their behavior to lose weight and lower their risk for many diseases.”
In an invited commentary on the article4, Robert B. Baron, M.D., M.S. from the University of California, San Francisco, suggests “implementing a simple office based strategy for initiating weight management. First, all patients should have weight and height measured and BMI calculated at each visit, treating BMI as a routine vital sign.” … “Physicians should then straightforwardly inform patients of their abnormal weight in a manner analogous to telling patients that their blood pressure or blood cholesterol level is elevated.”
“In addition to office-based approaches, we must advocate for population-based strategies to promote healthy eating and increased physical activity, such as listing calories on menus, more farmers’ markets, and more walking and bicycling trails. Without increased individual and population-based interventions, it is likely that obesity and obesity-related conditions will only increase in the coming years.”
1. Arch Intern Med. 2011; 171:306-313.
2. Arch Intern Med. 2011; 171:313-315.
3. Arch Intern Med. 2011;171:316-321
4. Arch Intern Med. 2011; 171:321-322.