IOM Obesity Report: How Physicians Can Fight Obesity

Physicians need more tools and support to help patients combat obesity. They also need to improve their bedside manner. So said a workshop summary report today on obesity from the Institute of Medicine.

Obstacles for Treating Obese Patients

Daily interactions within a patient’s family or community carry more influence than a brief conversation in an exam room with a health care provider. Most patients have little contact with their physician, often just once or twice per year and not always with the same doctor.

“People are much more heavily influenced by the places that they live, where they go to school, where they go to work, and so on, than they are by their health care providers,” said Loel Solomon, vice president of Community Health for Kaiser Permanente.

BMI is insufficient. Knowing a patient’s BMI is a diagnostic gauge but isn’t the whole picture. Physicians also need to assess diet and physical activity to help patients change habits. Solomon suggested physicians and other health care practitioners review the “5 As”:

• Asking patients about their readiness to change
• Assessing their risks
• Advising them on therapeutic alternatives
• Agreeing on treatment plans, and
• Assisting with or arranging for the resources necessary for people to take action

The quality of advice needs to improve. The report writes, “many providers are not prepared to have the delicate and complex conversations needed with overweight and obese patients.” Some private insurers and other organizations have developed online training for providers, including handling patient interactions to generate conversations that lead to patient action. Many patients consider the term “obese” a derogatory word instead of a medical diagnosis. Physicians need to think about their approach to get buy-in instead of refusal for patient treatments.

Solomon continues that a quality encounter is one that creates change in patient behavior, “people who are overweight and obese already have plenty of motivation to change.”

Behavioral scientists suggest focusing on lowering the bar to produce change. This includes patient interaction, access to resources such as nutritionists and support groups, and follow-up care within a medical facility. An “integration between clinic and community is critical.”

How Health Care Facilities Can Help

While physicians are on the front lines of obesity, it is the facilities they work in that must also help support the patient. The report recommends:

• Assessment and technical assistance for clinical practices
• A registry of overweight and obese patients
• Clinical guidelines that are relatively simple and easy to follow
• Data metrics and reports from providers and health care systems, including adherence to guidelines
• Expanded health teams that include dietitians, health coaches, social workers, medical assistants, and community health workers
• Physician training and engagement in advocacy around evidence-based community intervention
• Reimbursement reform to support physicians and their patients

How Doctors Can Approach Patients

A study at Yale Rudd Center asked patients how they felt about certain words to describe obesity. The following are considered desirable:

• Weight
• Excess Weight
• BMI

The following are considered undesirable and are best avoided during a patient consultation:

• Fatness                       • Excess Fat
• Obesity                       • Large size
• Heaviness                   • Unhealthy BMI
• Weight Problem        • Unhealthy body weight

They also suggest certain phrases such as “Mrs. Smith, could we talk about your weight today?” instead of “Mrs. Smith, we need to talk about your obesity.”

The full 81 page IOM report is available for free download. As a physician, have you had issues approaching your patients about weight issues? Have you implemented any programs in your practice that were successful?

We’ll be discussing all this and more inside Sermo. If you’re an M.D. or D.O. please join us.