By: Keri Peterson, MD —
February 28, 2018 — As a primary care physician, one of the most common issues I address with patients is how to manage their weight. According to a Harris Poll conducted for the Calorie Control Council among over 2,000 U.S. adults, 72 percent of Americans want to lose weight and on average want to lose 38 pounds. This presents many challenges to physicians for a variety of reasons. Achieving weight loss and then maintaining it is very difficult. According to the same Harris Poll, only 14 percent of people who have successfully lost weight have been able to keep it off for more than five years. The National Weight Loss Registry notes modifying food intake and increasing physical activity as common changes made by individuals that successfully lose weight and maintain that loss.
Time constraint is one limitation for physicians. Obtaining a food diary and reviewing it is critical to understanding and counseling a patient on where to make modifications. This takes time and patience. One incentive to be aware of is that Medicare reimburses a number of lifestyle and weight management codes. A few descriptions and coverage areas include intensive behavioral therapy for obesity which is a face-to-face behavioral counseling by a primary care physician (PCP) in a primary care setting for 15 minutes for patients with obesity. They will cover up to one visit per week in month one and one visit every other week for months two through six. Another is intensive behavioral therapy to reduce cardiovascular disease risk. This can be used for adults with well-known cardiovascular disease risk factors.
One of the perceptions among patients is that diet pills will help patients achieve sustainable weight loss, be it by “kickstarting” the process or getting the weight off and believing they will figure out a maintenance plan afterwards The Harris Poll found that 11 percent use dietary supplements to achieve weight management goals. Interestingly, adults aged 18-44 are more than three times as likely to use them as their older counterparts. This may be in part due to side effects of appetite suppressants such as elevation of blood pressure that are prohibitive to those with hypertension who tend to be older. It may also be due to the realization that they do not work to maintain goal weight over long periods of time.
A recent editorial (“Counting Calories as an Approach to Achieve Weight Control”) in The Journal of the American Medical Association (JAMA) eloquently discussed how important it is to teach patients that by modestly reducing calories, they can lose weight.
Dr. Eve Guth, author of the editorial, points out that it takes a net deficit of 3500 calories per week to lose one pound. (Click here to access the article – subscription required). That is a pragmatic way to explain it to patients and one that I have utilized with success in my practice as well. It gives patients a concrete formula to follow- if I eat 500 calories less per day or burn 500 calories more per day then I will lose one pound a week. This can be as simple as swapping out 40 ounces of full sugar sodas for low calorie sweetened beverages or water.
Another barrier is the strong cultural role that food plays in diet. Various ethnicities routinely have certain carbohydrate laden caloric foods as part of their daily meal such as rice, beans or pasta and bread. When the entire family sits down to a meal these foods are invariably on the table and are difficult to resist. In this scenario, rather than asking the patient to cut out the food altogether, portion control is a more realistic option.
We as physicians can play a pivotal role in tackling the obesity epidemic for our patients through encouraging them to make healthier choices. Physicians also play a critical role in identifying other healthcare professionals such as dietitians, exercise professionals, and nursing professionals that provide critical expertise and can support a patient as they address the multi-faceted aspects of obesity and chronic diseases. The question is are we up to the challenge?
Keri Peterson, MD is a medical contributor and columnist for Women’s Health and a frequent guest on NBC’s Today, ABC’s Good Morning America, Fox News and CNN. Based in New York City, Dr. Peterson has been in private practice since 1999 and holds appointments at Lenox Hill Hospital and Mount Sinai Medical Center. With a BA from Cornell University and a Medical Degree from Mount Sinai School of Medicine, she completed post-graduate training in Internal Medicine at New York’s Mount Sinai Medical Center and is board certified in Internal Medicine. Dr. Peterson is a member of the American College of Physicians and the American Medical Association, and serves as a medical advisor for the Calorie Control Council.