Implementation of a Primary Care Physician Network Obesity Management Program

Abstract

Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10‐minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House‐Calls, Mobile, AL). Patients were seen for follow‐up by their physician at weeks 4, 12, 24, 36 and 52. A total of 252 patients (202 women and 50 men) were referred by 18 primary care physicians to the program. The comorbid conditions reported for all patients at baseline included low back pain, 29% (n = 72); hypertension, 45% (n = 113); hypercholesterolemia, 41% (n = 104); type 2 diabetes, 10% (n = 26); and sleep apnea, 5% (n = 12). When offered a choice of meal plans based on foods or meal replacements, two‐thirds of patients (n = 166) chose to use meal replacements (Ultra Slim‐Fast; Slim‐Fast Foods Co., West Palm Beach, FL) at least once daily. Baseline weights of subjects averaged 200 ± 46 lb for women (n = 202) and 237 ± 45 lb for men (n = 50). Patients completing 6 months in the program lost an average of 19.0 ± 4.0 lb for women (n = 94) and 15.5 ± 8.2 lb for men (n = 26). Physicians reported a high degree of satisfaction with the program, suggesting that a brief, effective physician‐directed program with nutritionist support by telephone can be implemented in a busy primary care office.

Trends in professional advice to lose weight among obese adults, 1994 to 2000

“…Studies have shown that professional advice and followup with obese patients influence their motivation to make changes in diet and exercise and may promote successful weight loss. 20,21,[36][37][38][39][40] There is a need for reimbursement mechanisms that allow providers to give their patients sufficient weight reduction counseling and that link this counseling with reimbursement for intensive, evidence-based, behavioral interventions to lose weight. 28,34 Also, training in nutrition and exercise guidelines would give physicians a foundation for and perhaps a greater disposition toward addressing these problems with patients.…”

“…However, studies reveal that patients counseled regarding their weight or strategies for improving diet and exercise are substantially more likely to report that they are working on these areas, 20,21,36,37 and may be more likely to lose weight. 37,38 Finally, a review of randomized control trials indicates that coordination of weight loss efforts with a health professional may result in greater success among overweight or obese patients. 39 The U.S. Preventive Services Task Force recently concluded that there is some evidence that high-intensity counseling about diet, exercise, or both in conjunction with behavioral interventions produces modest, sustained weight loss in adults who are obese.…”

Effects of tea combined with high-protein meal replacement shakes on anthropometric measurements, lipid profiles, cellular biochemistry, neurochemistry, and microbial metabolism: a prospective observational study

“…[2][3][4][5] Calorie restriction, without malnutrition of essential nutrients, may also improve mitochondria efficiency and reduce oxidative stress in association with decreases in DNA damage and 24-hour energy expenditure. 6,7,12,45 As shown previously for other commercially available meal 12 NutriSystem (Fort Washington, PA), 13 Healthy Solutions (Health Management Resources® Corporation (HMR), Boston, MA), 14 Standard Process (Palmyra, WI), 15 and Ultra-Slim Fast (Unilever Bestfoods, Englewood Cliffs, NJ), 46 the Isagenix 28-day program is an effective and safe weight loss program. Increasing the number of evidence-based weight management interventions available to clinicians for disease prevention is important to address the individualized eating habits of patients and the constraints of time, knowledge, and costs of the providing clinicians.…”

Recognition, diagnosis and management of obesity after myocardial infarction

“…19 Until recently, Medicare, Medicaid and major health insurance companies did not officially considered obesity as a disease and do not generally reimburse for obesity treatment, unless related comorbidities exist. 20,21 Also, before strong evidence from large prospective studies controlling for several potential confounders showed a solid and independent association between obesity and cardiovascular disease, there was major controversy on whether or not obesity was related to atherosclerosis. 22,23 Moreover, the Framingham risk score, one of the most widely used methods for estimating cardiovascular risk, does not include obesity in the equation.…”