Communicating with my patients is at the core of my role as a practicing physician. I strive to build rapport, hear what my patients are saying, and make sure that they come away from our discussions with tangible strategies and a better understanding of their options to address their health. Effective communication is a skill that takes training and practice, and all of us can benefit from guidance on how to better communicate. Particularly when it comes to the topic of weight, it is a necessity to be able to discuss these issues in a caring, compassionate manner.

A literature review conducted by the STOP Obesity Alliance research team at George Washington University found that providers report several common barriers to discussing and treating obesity. One of the key conclusions is that there is a lack of resources to address the problem. The Alliance is working to fill that gap by developing a discussion tool to help providers have more productive conversations with their patients about weight. Based on the concept of STOP's Weigh In guide that helps parents and caregivers to communicate with children about weight and health, the provider discussion tool will offer scenarios that may occur in a health care setting and include advice on ways to address these issues.

STOP hopes to offer guidance for providers on how to begin the sometimes difficult conversation about weight, build trust with patients, and develop strategies to help open opportunities for treatment.

To facilitate development of the tool, STOP convened a cross-section of experts in the fields of obesity medicine, nursing, nutrition, health communication, and primary care, among others, who participated in a roundtable this month at the George Washington University. We discussed many roadblocks to effective conversation, including stigma, unrealistic expectations, minimal reimbursement, and lack of training. Stigma came up throughout our conversations and many of the experts reiterated its pervasive effects, one of which, and perhaps the most damaging, is to quell conversation and make patients feel they can't openly discuss their health concerns for fear of a negative response.  

Efforts to create methods for effective, non-stigmatizing conversations with patients continue to grow as more people recognize the importance of addressing obesity. For example, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation this month to give a grade of "B" to intensive behavioral counseling without co-pays to help overweight and obese patients at risk for cardiovascular problems adopt healthier lifestyles and diets. This means, per the Affordable Care Act, insurers should cover counseling for this population. This is great news and provides access to a much needed service. Effective counseling has been shown to result in improved health outcomes for patients, including reduced weight, blood sugar, blood pressure and cholesterol.

And the Centers for Medicare and Medicaid Services (CMS), beginning in July, will allow hospital registered dietitians to write therapeutic diet orders for patients without having to get prior approval from physicians. This revised federal rule will hopefully improve care and lower costs.

I look forward to keeping you posted on our progress as we develop this tool. If you are interested in learning more, or have specific ideas for what needs to be included, please contact us at obesity@gwu.edu.

Sincerely,

 

Always Hungry? Here's Why

May 16, 2014

The New York Times

By David S. Ludwig and Mark I. Friedman

The article discusses a reason why, according to the authors, exerting willpower and eating less, the longstanding solution for obesity, does not work. The article says that the process of gaining weight is what causes an individual to overeat. The article argues that addressing the underlying biological drive to overeat may make for a far more practical and effective solution to obesity than counting calories.

Stigma Makes Weight Loss Harder for Teens with Severe Overweight 

May 14, 2014

Endocrine Today

A survey of United Kingdom teens with obesity and overweight found that social barriers, stigma, teasing and abuse stand between most heavy teens and weight loss that could improve their overall health. Most teens focused considerably on the social implications of obesity rather than on health and reported "severe, unrelenting size-related abuse and isolation." The findings were published in BMJ Open.

CMS Gives Hospital Workers More Nutrition Autonomy 

May 14, 2014

HealthLeaders Media

By John Commins

Starting July 11, hospital registered dietitians (RDs) will have the authority to write therapeutic diet orders for patients without necessarily getting prior approval from physicians. The enhanced autonomy for RDs is part of sweeping rules changes that the Centers for Medicare and Medicaid Services believes can save about $3.4 billion over five years. The new rules respond to President Obama's 2011 Executive Order 13563, which encouraged the federal bureaucracy to reduce or revise antiquated and unnecessarily burdensome rules and regulations.

New Obesity Guidelines to Debut at AACE 

May 13, 2014

MedPage Today

By Kristina Fiore

The American Association of Clinical Endocrinologists (AACE) debuted its own obesity guidelines at its annual meeting, charting a different course from other national obesity guidelines released last fall, according to the article. In the guidelines, AACE is calling for a "complications-centric" approach to treating the disease, rather than relying on BMI.

USPSTF: Obese Patients Need Counseling for Heart Health 

May 13, 2014

MedPage Today

By Salynn Boyles

Obese and overweight adults with at least one other cardiovascular risk factor should receive intensive behavioral counseling to promote healthy diet and physical activity for heart disease prevention, according to a U.S. Preventive Services Task Force (USPSTF) preliminary recommendation. The new USPSTF recommendations build on the new science and focus on overweight or obese people with various cardiovascular risk factors and include a physical activity component as well as a dietary component.

Obesity Can Be a Disability, Court Rules 

April 28, 2014

The Wall Street Journal

By Gregory J. Millman

A federal district court ruled that obesity itself may be a disability, independent of an underlying physiological condition, confirming the rising risk of lawsuits on grounds of obesity discrimination reported by Risk & Compliance Journal. According to an attorney quoted in the article, the lawsuit may push employers to view "obesity, at least severe obesity, [as] a disability regardless of whether there is an underlying physiological condition involved, and [to] seek a reasonable accommodation if the disability interferes with job performance."