With the rising prevalence of obesity, physicians need to focus on teaching patients about healthy lifestyle behaviors, especially weight management.

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With the rising prevalence of obesity, physicians
need to focus on teaching patients about healthy
lifestyle behaviors, especially weight management.
Conversations about Weight Loss Can
Promote Behavior Change in Patients
Medical Transcription Services
United States

2. www.medicaltranscriptionservicecompany.com 918-221-7809
With multiplying documentation demands and population health goals, physicians bear
much more responsibility than they did in previous years. A main advantage of outsourcing
medical transcription is that it allows physicians to focus their attention on the clinical
relationship with the patient and spend more time with them. One of the areas that
physicians need to focus on is teaching patients about healthy lifestyle behaviors, especially
weight management.
According to the statistics cited by the Centers for Disease Control and Prevention (CDC),
obesity affected 39.8% of Americans (about 93.3 million adults) in 2015-2016. Patients
need to be made aware of the necessity to reduce their weight, as extra weight is linked to
diseases such as diabetes, sleep apnea, high blood pressure, stroke and some types of
cancers. Communication is the first step to help patients take control of their weight.
In 2013, the American Medical Association (AMA) declared obesity a disease, making it
important that all physicians collaborate with dietitians and other health care professionals
to screen for, diagnose, treat, manage, and prevent obesity, just as they do other diseases.
A 2014 study of National Health and Nutritional Examination Survey (NHANES) data
reported that patients whose physicians had informed them that they were overweight were
much more likely to make healthy lifestyle changes to lose weight. The team concluded that
people who are overweight and aware about this would not change their current behaviors
unless physicians talked about their weight. It is therefore the physician’s responsibility to
raise the issue. However, physicians face many challenges when it comes to engaging with
patients about their weight:
- Weight is not an easy subject: Weight is a complex and sensitive issue, and
physicians find it difficult to broach the topic with their patients. Many providers are
not sure about what words to use when talking about weight, while supporting their
patients in an empowering and nonjudgmental manner
- Lack of nutrition education and training: Medical education does not provide
physicians with knowledge about nutrition. Medical professionals do understand
nutrition science, but most do not know how to translate it into practical advice for
patients, such as what foods to avoid and how to cook, says David Eisenberg, MD,
associate professor of Nutrition at Harvard T.H. Chan School of Public Health and
executive vice president for Health Research and Education at the Samueli Institute.

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- Time constraints: Providers may not have enough time for such conversations at
the appointment. In a 2018 NPR article, Ashley Mason, a behavioral psychologist at
the University of California, San Francisco's Biology and Experience of Eating Lab
points out that 14-minute visits with the primary care physician “aren't enough time
for everything”.
- Insufficient reimbursement: This is actually no longer a reason for not providing
weight management counseling. Starting November 2011, CMS began reimbursing
primary care physicians for obesity counseling by introducing Healthcare Common
Procedure Coding System (HCPCS) code G0447, Face-to-face behavioral counseling
for obesity, 15 minutes. Providers can bill for weight management counseling
provided therapy for obesity meets CMS guidelines and is consistent with the 5-A
(assess, advise, agree, assist and arrange) framework delineated by the US
Preventive Services Task Force (USPSTF).
According to CMS, therapy for obesity consists of:
- Screening for obesity in adults using measurement of BMI calculated by dividing
weight in kilograms by the square of height in meters (expressed kg/m2)
- Dietary (nutritional) assessment; and
- Intensive behavioral counseling and behavioral therapy to promote sustained weight
loss through high intensity interventions on diet and exercise.
Not discussing a plan to address obesity at the office visit increases patients’ risks of
developing or aggravating conditions like diabetes and high blood pressure, leading in turn,
to negative health outcomes. Even moderate, 5‐10% sustained weight loss can improve
health.
How can physicians talk to patients about weight management? A health.gov article written
on behalf of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
offers the following guidance:
o Initiate the discussion about weight in a respectful and nonjudgmental way.
Using terms patients prefer may improve patient communication and care.
Surveys show that patients prefer “weight” and “BMI” and dislike “fatness,”
“excess fat,” and “obesity.”
o Dietary advice should take account of the patient’s culture, including
perceptions about weight, favorite foods, social norms and practices, and
related issues. Researchers say that asking patients about their goals, ideal

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body type, comfort with physical activity, diet advice and other issues can
make individualized weight management counseling much more effective.
o Physicians should ask questions that promote dialogue. This will encourage
even patients to not ready to attempt weight loss to think about making
positive lifestyle changes.
o When patients are willing to change habits, the physician should focus on
initiating action by working with them to create and implement a plan to
improve their health. Those who are not ready to commit to a weight loss
plan can be advised on avoiding further weight gain by reducing consumption
of sugary foods, unhealthy fats, and salt.
The NPR article draws attention to the latest USPSTF recommendation that treatment plans
for a patient whose body mass index is over 30 should also include a referral to an intensive
weight-loss program that involve dietitians, lifestyle coaches and psychologists.
Research has convinced the USPSTF about the effectiveness of intensive weight loss
programs lasting between one and two years. These programs use different strategies for
behavior change, but most promoted self-monitoring of weight among patients with tools to
maintain weight loss, like scales, pedometers, or exercise videos as well as counseling.
Primary care physicians can get training in nutrition, exercise, and motivational interviewing
which could improve delivery of obesity care and weight loss counseling. In the longer term,
changes to medical curricula to include the integration of multidisciplinary education or
‘collaborative care’ models can help.
In the face of time and resource pressures, many physicians may find it challenging to
deliver intensive behavioral weight loss interventions supported by the best scientific
evidence. As clinicians focus on improving conversations about weight and health,
outsourced medical transcription services are a great option when it comes to saving time,
meeting documentation demands, and maintaining work-life balance.