When I read last week that the U.S. Preventive Services Task Force recommended that primary care physicians not only screen adults for obesity but recommend “intensive, multicomponent behavior interventions,” I wondered why that wasn’t already happening.
Patrick O’Neil, president of The Obesity Society and the director of the Weight Management Center at the Medical University of South Carolina, told me why it wasn’t.
“It’s been an issue that both doctors and patients have avoided,” says O’Neil, who has worked in the field for three decades.
O’Neil says he thinks doctors struggle because of time and staff constraints, as well as perhaps lacking some psychological training when comes to talking about weight issues with patients.
He also noted that some patients might be offended by a discussion about their weight.
“The examining room gets to be a minefield,” says O’Neil.
But he hopes the task force’s recommendation will help encourage both doctors and patients to be open to the process, though it may require more public awareness.
“With almost any message to large numbers of people, it’s naive to think you only need to say it once to make it be a part of common practice.”
The task force set the standard for referrals to an intervention program at a body mass index of 30 higher. BMI is calculated from the measured weight and height of an individual. And while it noted that waist circumference may be an acceptable alternative to BMI in some patient populations, it didn’t specify any numbers.
“The USPSTF found adequate evidence that intensive, multicomponent behavioral interventions for obese adults can lead to an average weight loss of 4 to 7 kg (8.8 to 15.4 pounds),” the report states. “These interventions also improve glucose tolerance and other physiologic risk factors for cardiovascular disease.”
But the task force, which has made some controversial recommendations in the past three years, added that it “found inadequate direct evidence about the effectiveness of these interventions on long-term health outcomes (for example, death, cardiovascular disease and hospitalizations).”
If the task force sounds familiar, it’s the same group that caused major stirs by recommending that women in their 40s forgo mammograms and that healthy men forgo prostate-specific antigen tests to screen for prostate cancer.
The group said the screenings did little to no good. Some oncologists, urologists and advocates disagreed.
But O’Neil applauds the recommendation for treatment as another small victory in the battle in the obesity epidemic.
Perhaps the greater benefit of the recommendation, he adds, is that it is a signal to insurance companies that they should start covering the costs of obesity intervention programs.
Currently, some insurance companies pay only for the most extreme treatments such as bariatric surgery but not the interventions that ultimately could cost less than surgery.
And as far as which programs doctors should refer patients to, O’Neil says The Obesity Society expects to finalize a certification process in the fall so that a third party can verify which programs are following the best practices for effective weight loss.
O’Neil adds that family doctors can’t be expected to be a gatekeeper for which programs patients go to but certainly could be reliable signposts.