An important addition to the “eat less, move more” strategy for weight loss lies in behavioral counseling to achieve these goals. But research on how primary care practitioners can best provide behavioral weight loss counseling to obese patients in their practices  — as encouraged by the Centers for Medicare and Medicaid Services (CMS) — remains slim, according to a systematic review of this topic published today in JAMA. The study was led by researchers from the Perelman School of Medicine at the University of Pennsylvania.

“After an exhaustive search, we found only 12 high quality randomized controlled trials that examined the behavioral treatment of obesity in patients encountered in primary care settings,” said Thomas A. Wadden, PhD, director of Penn’s Center for Weight and Eating Disorders and the review’s lead author. “Of those, only two studies identified counseling interventions that produced an average loss of at least five percent of initial body weight, an amount likely to improve weight-related health complications.”

The researchers initiated their review in response to two important policy developments in weight management. In 2003 (and again in 2012), the U.S. Preventive Services Task Force recommended that primary care practitioners screen all adults for obesity and offer or refer affected individuals to an intensive, multicomponent weight loss intervention (typically aimed at modifying diet, physical activity and related behaviors) .  In 2011, CMS approved payment for intensive behavioral weight loss counseling, consisting of approximately 14 face-to-face, 10 to 15 minute sessions over six months, for obese individuals treated in primary care settings. 

“The CMS’s decision to reimburse the cost of intensive behavioral counseling for Medicare-eligible patients was an important step in advancing the treatment of a disease that has long been overlooked,” said Adam Tsai, MD, a co-author of the review and an internal medicine and obesity specialist at Kaiser Permanente in Denver.

However, the researchers did not find any studies in which primary care practitioners delivered behavioral counseling following the exact CMS guidelines. Among other requirements, these guidelines specify that behavioral weight loss counseling must be provided by CMS-defined practitioners, who currently are limited to physicians, nurse practitioners, clinical nurse specialists and physician assistants. Counseling potentially may be provided by auxiliary health professionals, such as registered dietitians, who work in the same physical setting as the primary care practitioners and are directly supervised by them. However, no such studies were identified in the review. Auxiliary health providers cannot provide weight loss counseling independently of primary care providers under current CMS guidelines.

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