Can effective obesity counseling fit into the 20-minute appointment?

CO-DEVELOP A TREATMENT PLAN AND ADDRESS POTENTIAL BARRIERS

The most effective weight loss treatment consists of in-person consultations in which comprehensive lifestyle interventions are included. The components of an effective intervention (Table 1) include a reduced-calorie diet, aerobic physical activity, and behavioral strategies to meaningfully support these changes.²

We recommend addressing potential barriers to initiating and maintaining weight-loss interventions, and revisiting them during follow-up visits. Barriers include the following:

Depression

Adults with depression are more likely to be obese than adults without depression, and the age-adjusted percentage of adults who are obese increases as depression severity increases.¹¹

Access to healthy foods

Limited access to healthy food choices can lead to poor diets and higher levels of obesity.¹² Local grocery store websites and nutrition specialists can help identify a range of healthy and affordable food to sustain a dietary intervention.

Medications associated with weight gain

Certain diabetic medications, contraceptives, tricyclic antidepressants, atypical antipsychotics, antiseizure drugs, and glucocorticoids promote weight gain and may have alternatives that do not promote weight gain.¹³

ARRANGE FOLLOW-UP AND REFERRALS

The literature supports frequent in-person sessions as the basis for a successful weight loss intervention (ie, ≥ 14 sessions in 6 months).² Medicare beneficiaries are eligible for 14 covered visits in the first 6 months and become eligible for an additional monthly visit over the course of 6 subsequent months if a weight loss goal of 3 kg is met in the first 6-month period.

Nutritionists, dieticians, and behavioral psychologists are often instrumental in comprehensive weight loss interventions. Anti­obesity drugs help curb appetite, promote weight loss, help enhance adherence to lifestyle modifications, and make it easier for patients to start a program of physical activity.¹⁴

The joint 2013 guidelines² recommend referral for bariatric surgery for adults with a BMI 40 kg/m² or higher, or for adults with a BMI 35 kg/m² or higher and obesity-related comorbidities who have not responded to behavioral treatment (with or without pharmacotherapy).

A growing body of evidence promotes the use of group support sessions such as shared medical appointments to encourage healthy eating and physical activity.¹⁵

OBESITY COUNSELING IS ACHIEVABLE AND REIMBURSABLE

To receive reimbursement from Medicare for obesity counseling, the information listed under “assess” and “advise” in Table 1 should be obtained in the initial visit; and follow-up visits should be used to address items under “agree,” “assist,” and “arrange.” Up to 20 visits are eligible for reimbursement when patients meet the goal of a 3-kg weight loss in the first 6 months (or 14 visits).