Health-care providers are struggling in the nation’s war against obesity, but as a nurse practitioner (NP) or physician assistant (PA), you can make a difference by providing weight-loss guidance on an ongoing basis to your patients. 


Patients want us to get involved and give them individualized and detailed weight-loss plans. For example, one study found that 82% of persons who are either overweight or obese would like help from their family physicians.1

But other research has shown that providers can be reluctant to discuss weight reduction, and have avoided the subject due to
 fear of offending the patient.2 Providers may feel discouraged and perhaps ineffective in the area of weight-loss counseling and may shy away from engaging in this practice.


However, quality of clinician counseling can influence patient motivation to lose weight and intentions to change behavior.3 NPs and PAs need to be familiar with effective weight-loss strategies and comfortable discussing these tactics with patients. 


It is also important for clinicians to calculate and discuss with the patient the patient’s BMI, waist circumference, and waist-to-hip ratio. A person with a BMI >25 is considered overweight, and a person with a BMI >30 is considered obese. Waist circumference >40 inches for men and >35 inches for women is considered high. Waist-to-hip ratios >0.85 for women and >1.0 for men fall into the high-risk category.


Encourage patients to become acquainted with calorie counts of foods and explain to them how making small changes each day can lead to significant weight loss over time. For example, cutting out just 100 calories a day can lead to a 10-lb. weight loss in a year. 


In June 2013, the American Medical Association officially recognized obesity as a disease. The Centers for Medicare and Medicaid Services already (as of December 2011) reimburses for behavioral counseling of obese patients (defined as a BMI ≥ 30) delivered in the primary-care setting.

NPs and PAs can bill for these services. Reimbursable benefits include weekly face-to-face counseling for a month, then every-other-week counseling for five months. Patients who have lost at least 6.6 lbs at the end of six months are entitled to receive six more monthly counseling sessions. Behavioral counseling must be consistent with the five As: assess, advise, agree, assist, and arrange.


NPs and PAs can make a difference in fighting obesity. We must be willing to take the following steps:


  • Familiarize ourselves with successful weight-loss strategies 

  • Talk about weight issues with patients

  • Obtain physiologic measurements from the patient on an ongoing basis

  • Use every opportunity to employ successful strategies to help patients lose weight 

  • Stay current on effective weight-counseling techniques

  • Refer patients to a nutritionist when needed


As clinicians, we can better engage in the weight-loss battle if we are aware and equipped to make a difference in the lives of the patients we serve. Additional information on this topic is available at www.cdc.gov/obesity/.

References

  1. Diabetes Educ. 2006;32:557-561
  2. J Am Acad Nurse Pract. 2009;21:454-460
  3. BMC Health Serv Res. 2010;10:159, available at www.biomedcentral.com/1472-6963/10/159/; accessed September 15, 2013