The Importance of Intervention: The Obese Patient and the PCP

the MPR take:

The Centers for Medicare & Medicaid Services (CMS) approved in 2011 intensive behavioral weight loss counseling for obese beneficiaries seen in primary care practices over the course of approximately 14 face-to-face sessions over six months. This frequency of behavioral counseling is consistent with recommendations from the US Preventive Services Task Force (USPSTF), but does evidence from randomized controlled trials support this type of intervention? A review of 12 randomized controlled trials published from January 1980 to June 2014 yielded no published studies in which primary care practitioners delivered counseling that followed the CMS guidelines. Three trials with brief monthly counseling sessions by trained medical assistants with primary care practitioners had mean weight losses at six months of 3.5–4.4kg, but a decline in amount of weight lost was seen during the follow-up period with less frequent sessions. Two trials strongly supported the intervention frequency recommended by CMS, with one conducting counseling face-to-face and one via telephone or email. Trials that did not include a comprehensive lifestyle intervention with a reduced calorie diet, physical activity, and behavioral strategies resulted in smaller observed weight losses. A significant research gap exists for randomized controlled trials analyzing intensive behavioral counseling following the CMS guidelines, but the importance of medical professionals in counseling obese patients on lifestyle interventions is apparent in the published studies.

Importance: In 2011, the Centers for Medicare & Medicaid Services (CMS) approved intensive behavioral weight loss counseling for approximately 14 face-to-face, 10- to 15-minute sessions over 6 months for obese beneficiaries in primary care settings, when delivered by physicians and other CMS-defined primary care practitioners.

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