Doctors To Screen Patients For Obesity?

I’ve always counseled my patients about the need to keep a healthy weight. It not only makes you look and feel better but it decreases your risk for serious diseases.   Many doctors, though, have shied away from telling their patients that they need to lose weight. Why? For one reason, patients tend to take comments about their weight very personally instead of seeing it as the health risk that it is.  Many doctors don’t want to insult their patients and/or make them feel bad about themselves in any way.

For another reason, some doctors feel that nutrition and weight loss counseling is not within the scope of their chosen field of practice.  Usually, nutrition and weight loss strategies are subjects more completely studied in the field of dietetics or nutrition.  Additionally, a patient’s insurance may not pay for obesity screening, or weight loss programs, and a patient may not want to pay the out of pocket fees.  If the U.S. Preventive Services Task Force (USPST) has their way, though, all that can soon change. All insurance companies could soon begin to pay for weight loss programs. As a result, your doctor may soon screen you for obesity at your next exam.

What is Obesity Screening?      

In 2003, the USPST recommended that doctors screen all their patients for obesity.  Some doctors began to do weight loss/nutritional programs with counselors/health coaches attached to their practices to meet the weight loss needs of their patients.  Others simply handed out the standard 1,200 calorie diet and told their patients to follow it.  Yet, obesity statistics continued to rise.  With more than 30% of adults in the United States obese, increasing the risk for heart disease and diabetes, it’s clear that something more needs to be done.  The USPST feels that personal doctors should be the first line of help for their obese patients and I agree.

Today in 2012, the USPST has amended their original decree to take it a little further.  They are now recommending, not only that your doctor screen you for obesity, but also advise an intensive counseling and/or a weight loss program. This program can either be through your doctor’s services or at a separate facility in your community.

The USPST is also recommending doctors to counsel other “at-risk” patients about other specific lifestyle choices – alcohol, smoking, drug addiction, etc – and refer them to the appropriate services for counsel.

Here’s what obesity screening may look like:

1.  Body mass index measurements.  This involves calculating the ratio of a person’s weight to their height. For example, a person who is 5’3” tall and weighs 180 has a BMI of 31. BMI’s over 30 are deemed obese, while 25-29.9 is overweight, and 18-24.9 is considered normal.

2.  Waist measurement.  A waist measurement over 35” in women, and 40” in men, no matter what the weight is, is a strong indicator of increased risk for heart disease and diabetes.  It shows that too much fat is stored in the abdomen around your critical organs.

What Makes An Obesity Management Program?

When I counsel my patients about weight loss, I don’t give them the standard 1,200 calorie weight reduction diet.  I know this doesn’t work very well in the long-term.  Anyone can have some success with just about any “diet” out there if they stick to it long enough.  Without also instructing patients how to manage their weight loss, though, they typically regain it when they revert to old eating habits.

The USPST recommends many of the same principles I include in my weight management programs:

1.    Behavioral intervention.  Helping the patient identify certain behaviors that have lead to their obesity (eating too much of the wrong foods, not exercising enough, etc).

2.   Nutrition counseling.  I like to teach my patients about food composition – fats, proteins, carbohydrates, sugars – and how those components affect weight loss and gain. Despite what you may read, calories, fats, carbs, are not created equal.  I also emphasize portion control and how to accurately measure foods so my patients learn how much 4 or 8 ounces actually is. This teaches patients to become more aware, and accountable, for what, and how much, they’re eating.

3.  Physical activity.  I also stress the importance of balancing food/calorie intake with activity.  Typically, what causes most people to gain weight is a slowing down, or cutting out, of activity coupled with extra eating and a slower metabolism as you get older.  I recommend getting 30-40 minutes of aerobic exercise 3-4 times a week; resistance training of 30 minutes, 3 times a week.

4.  Supplements versus Prescription Medications. Many doctors advocate using drugs like Orlistat, Metformin, Xenical, etc to aid weight loss. Unless a person has type 2 diabetes, these medications may not be helpful and can have several side effects.  The USPST also does not recommend using “diet” drugs for weight loss. I don’t know the USPST’s stance on using natural supplements, but I always advocate a natural approach, including herbal supplements like green coffee bean extract and raspberry ketones, to help jump start weight loss.  Recent research has shown many natural products to be effective weight loss aids without side effects.

I believe obesity screening is a good idea to help lower the country’s obesity statistics, help people decrease their risk for heart disease and diabetes and just be healthier overall. To do some screening of your own, please see the BMI guidelines and food portion plate attached to this article.  They can help assess your own obesity risk and spur you to a healthier lifestyle.

Stay well,

Mark Rosenberg, M.D.