Ethics Forum. Posted June 4, 2012.

Nutrition is a major factor in an increasingly complex equation that determines overweight and obesity in the United States. Are physicians prepared to help patients improve this aspect of obesity prevention?

Reply:

Being overweight or obese increases the risk for many chronic health conditions. Even in the absence of excess weight, unhealthy food choices and physical inactivity are associated with major causes of morbidity and mortality, including cardiovascular disease, hypertension, type 2 diabetes, osteoporosis and some types of cancer. The high prevalence of these diseases begs that counseling in nutrition be offered as a part of good medical care. In many cases, such counseling becomes a necessity.

Recently, the Centers for Medicare & Medicaid Services announced that Medicare will pay for obesity counseling if it is coordinated by a primary care physician. CMS determined that the evidence is adequate to conclude that intensive behavioral therapyfor obesity, defined as a body mass index 30 kg/m2, is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B and is recommended with a grade of A or B by the [U.S. Preventive Services Task Force].

More people seek medical care services from a primary care physician than from any other source. Hence, the primary care physician should be the one to initiate discussions about nutrition. Perhaps the best time to do it is when explaining the management of the many chronic conditions that diet can affect, such as hypertension, hyperlipidemia and overweight.

Some points that physicians should share with patients:

The U.S. Dept. of Health and Human Services has developed evidence-based guidelines for nutrition and physical activity to promote health and reduce chronic disease risk. The recommendations of the Dietary Guidelines for Americans are exemplified by the Dietary Approach to Stop Hypertension (DASH) eating plan, which, in clinical trials, demonstrated health benefits, including lowering blood pressure, improving blood lipids and reducing cardiovascular disease risk and mortality. The Physical Activity Guidelines for Americans also contain recommendations for reducing chronic disease risk and managing weight.

The U.S. Preventive Services Task Force has determined that intensive behavioral dietary counseling is beneficial for adult patients with certain risk factors for cardiovascular disease or other diet-related chronic conditions (a grade B recommendation), but also that there is insufficient evidence to support routine counseling in unselected patients (grade I statement insufficient evidence available). A grade B recommendation also was given to screening adults for obesity and offering intensive counseling and behavioral interventions for obese adults. An I statement was given for counseling and screening overweight adults.

Whether physicians should be the ones to provide intensive counseling, however, is a little less clear. Because nutrition education is severely limited in most medical schools, the primary care physician may not be the person most qualified for the task. On average, medical students receive less than 20 contact hours of nutrition instruction during their medical school training. Hence, many do not feel equipped to give sound nutritional advice. In a recent survey of primarycare physicians, 78% said they had no prior training on weight-related issues; and 72% of those said no one in their office had weight-loss training.

See the original post:
Nutrition talks with patients: option or obligation?