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Preventive Services Task Force Endorses Obesity Screening, Counseling

By Judith Graham

June 25th, 2012, 5:10 PM

All adults should be screened for obesity, and those found to be obese should be offered at least 12 weeks of intensive counseling about lifestyle changes, the U.S. Preventive Services Task Force said in a statement published Monday in the Annals of Internal Medicine.

The recommendation is likely to accelerate insurance companies’ coverage of weight loss programs for obese adults – those with a body mass index  (a ratio of height to weight) of 30 or higher, experts said.

The Preventive Services Task Force, an independent group of experts that evaluates evidence supporting preventive medical services, first endorsed obesity screening in 2003.  What’s new is its finding that weight loss programs are effective if they last at least three months and include multiple strategies such as counseling about behavior change, nutrition and physical activity.

“If anything, the recommendations have been strengthened,” said Dr. David Grossman, a spokesman for the task force and senior investigator for preventive care at Group Health Research Institute.

Previously, the task force didn’t specify characteristics of programs that have a positive impact in controlling obesity.

“Having this guidance is really important, and my hope is that it will push forward greater reimbursement of these programs,” said Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago. Insurance companies differ in obesity-related policies and “often it’s hit or miss what they’ll pay for,” Lloyd-Jones added.

The Accountable Care Act requires that insurers cover preventive services endorsed by the Task Force – those with a grade of “A” or “B” — without charging co-payments or deductibles.  The new obesity recommendation carries a grade of “B.”

In its review of 58 weight-loss trials, the task force found that participants in programs lasting at least 12 weeks lost 8.8 to 15.4 pounds, or 6 percent of their baseline weight, on average.  Weight loss of 5 percent or more is considered “clinically important,” its statement notes.

The use of weight loss medications was not endorsed by the task force, because “we couldn’t find any evidence of studies that show patients’ success in maintaining weight loss after stopping the medication,” Grossman said.  Weight loss surgeries were not evaluated and screening for patients who are overweight but not obese was not recommended.

In a separate statement, the task force found weak support for counseling adults about how to prevent heart disease and strokes, two of America’s major killers.  This report applies only to patients without a history of cardiovascular disease or serious risk factors for these illnesses.

The task force previously examined counseling about healthy diets and physical activity separately.  The new statement on heart disease and stroke combines these activities and assigns a “C” grade to the recommendation that counseling be offered, based on individual patient’s circumstances and preferences.

“We recognize that leading a healthy lifestyle is critical to the prevention of cardiovascular disease and that reinforcing the importance of physical activity and a healthy diet in conversations with patients is valuable,” Grossman said.   “What we’re saying here is that primary care doctors can be selective in deciding which patients should be offered intensive counseling.”

“It’s almost a religious mantra that doctors are supposed to talk to patients about diet and exercise.   Now, the task force says they can’t document an impact for healthy patients, given the research that’s  available,” said Dr. Richard Stein, a spokesman for the American Heart Association and professor of medicine at New York University School of Medicine. “It doesn’t mean we’ll stop giving this kind of advice, but maybe we’ll spend less time doing so and focus more on other things that are more clinically important.”

4 Responses to “Preventive Services Task Force Endorses Obesity Screening, Counseling”

  1. John Spek says:

    Preventive Services Task Force Endorses Obesity Screening, Counseling

    Here is the predictable course of action that will alter policy costs

    HHS will mandate this into the health plan requirements using the rule/law writing parts of ACA

    Insurance companies will be forced to include it into new policies

    The added costs will allow the MLR to adjust

    That will allow them to ask for and get approval for rate increases

    And the insurance Cost Plus system will crank up costs to the policy holders

    and the next task force item will start this process all over again

    Mass started with a big list and found out policy costs could not be kept low when the wish list was high

  2. Janice Farris says:

    Rather than screening for obesity and offering counseling, wouldn’t it be better to promote eating healthy, natural foods that haven’t been ruined by the food manufacturer’s tinkering with our food supply? Study after study, that have been supressed, show that the modifications to our foods are causing the obesity epidemic. Seems like it would make more sense to go back to natural foods that don’t kill us than to continue to support and promote unhealthy foods that have been modified from their natural state. Counseling, without more natural foods, is not going to fix this problem.

  3. Judy Gould, MA, MS, RD says:

    Not one of the articles about obesity in KHN’s 6/26 e-mail mentions referral to registered dietitians. The IOM acknowledges RDs are the most appropriately educated and trained to provide medical nutrition therapy (MNT) for obesity and other nutrition-related diseases and medical conditions. MNT is comprised of a nutrition assessment, nutrition intervention, and nutrition re-assessment performed by RDs. “Nutrition counseling” is undefined as to provides it or what it covers. Blue Cross Blue Shield of Massachusetts and North Carolina cover MNT for 31 diagnoses and have adopted the Academy of Nutrition and Dietetics’ recommendations for minimum number of visits per diagnosis per year. MNT for obesity would automatically affect the development of diabetes and cardiovascular disease.

  4. Neal Kaufman says:

    These recommendation are correct, weight loss counseling needs to be a part of the care provided to patients, and the Diabetes Prevention Program protocol is the best weight loss counseling option there is. Los Angeles based DPS Health has spent the past 6 years developing and deploying Virtual Lifestyle Management, the only online version of the DPP. We have partners that offer VLM to patients, health plan members and employees to help them lose weight at a fraction of the cost of a face-to-face program. go to http://www.DPShealth.com to learn more.

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