Treating the Obese Patient: Suggestions for Primary Care Practice

Abstract

Obesity is a major health problem in America. Weight loss is associated with improvements in obesity-related health complications, but patients and practitioners are frequently disappointed by the long-term results of weight control efforts. Recent research has yielded new findings concerning the causes of obesity, as well as new goals for obesity treatment. Traditionally, the goal of therapy has been reduction to ideal weight. Several scientific bodies, however, now recommend a more modest 5% to 15% reduction in initial weight. Current options for weight loss include behavioral or pharmacological management provided during primary care visits, self-help and commercial programs, hospital-based interventions, and bariatric surgery. Regardless of the approach selected, long-term care usually is required to facilitate the maintenance of weight loss.

Treatment of Obesity in Primary Care Practice in the United States: A Systematic Review

“…The search covered 1950 to the present (last updated January, 2009). Bibliographies of studies, as well as of prior qualitative and systematic reviews, 13,15,[17][18][19][20][21] also were examined to ensure completeness of the search. Quality of studies was rated using the CONSORT criteria, as well as questions from the Agency for Healthcare Research and Quality's Methods Guide for Comparative Effectiveness Reviews.…”

“…6 Practitioners and researchers know little about the efficacy of behavioral weight loss interventions that can be delivered in primary care practice. 14,15 The primary goal of this review is to examine the results of studies that delivered behavioral counseling alone or in combination with pharmacotherapy.…”

Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies

“…The physician and office staff should always be sensitive and encouraging, even when patients have been unable to lose weight. It is important that patients feel understood and supported, not guilty or embarrassed, at office visits (101). Several techniques can be used in the office setting to promote behavior change (51,102-104).…”

“…Strategies such as self-monitoring (daily records of food intake and physical activity), stimulus control (avoiding triggers that prompt eating), and problem solving (identifying barriers and ways to overcome them) can support the change process during follow-up visits. Frequent patient-provider contact (e.g., weekly or biweekly) is associated with better longterm weight loss maintenance (101).…”

“…Long-term maintenance of weight loss is more challenging than initial weight reduction (101). Some strategies that are associated with successful long-term weight loss include eating a diet low in calories (ϳ1,400 kcal/day) and fat (24% of total energy intake), frequently monitoring body weight, and participating in regular physical activity (equivalent to 2,800 kcal/week or ϳ60 min of moderate activity/day) (56,79).…”