Primary Care Physicians Need Weight-Loss Tools

AbstractObjectiveThe present review aimed to examine the effectiveness of behavioural weight-loss interventions involving primary-care physicians in producing weight loss in overweight and obese primary-care patients.DesignA systematic review was conducted by searching online databases (MEDLINE, EMBASE, Cochrane, PsycINFO and SCOPUS) from January 1999 to December 2011. All abstracts were screened and coded for eligibility. The Cochrane Effective Practice and Organisation of Care Group quality criteria were used to assess the methodological adequacy of included studies. Information related to study design, population characteristics and intervention details was extracted.SettingPrimary care.SubjectsOverweight or obese (defined as having a BMI ≥ 25·0 kg/m2) primary-care patients.ResultsSixteen different studies were included. Of these, six assessed primary-care physicians’ delivery of weight-loss counselling; nine assessed weight-loss counselling delivered by non-physician personnel with monitoring by primary-care physicians; and one assessed a multi-component intervention. Overall, high-intensity weight-loss counselling by primary-care physicians resulted in moderate but not clinically significant weight loss. High-intensity weight-loss counselling delivered by non-physicians, meal replacements delivered in conjunction with dietitian counselling and referral to commercial weight-loss centre programmes accompanied by regular monitoring by a primary-care physician were effective in producing clinically significant weight loss. Dietitian-delivered care appeared effective in producing weight loss regardless of level of intervention intensity.ConclusionsOverall, there were few studies on this topic and the methodological rigour of some included studies was poor. Additional studies assessing the effectiveness and acceptability of potential interventions are needed to confirm these findings.

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A pilot study of primary care physicians’ attitude to weight loss surgery in England: are the young more prejudiced?

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2017.11.013 ◽

2018 ◽

Vol 14 (3) ◽

pp. 376-380 ◽

Cited By ~ 6

Author(s):

Emma Rose McGlone ◽

Laura R. Wingfield ◽

Aruna Munasinghe ◽

Rachel L. Batterham ◽

Marcus Reddy ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Pilot Study ◽

Primary Care Physicians ◽

Weight Loss Surgery

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Communication between patients and primary care physicians after behavioural weight loss: an observational study

Primary Health Care Research & Development ◽

10.1017/s1463423619000124 ◽

2019 ◽

Vol 20 ◽

Author(s):

Jocelyn E. Remmert ◽

Adam G. Tsai ◽

Savannah R. Roberts ◽

Meghan L. Butryn

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Weight Loss ◽

Observational Study ◽

Primary Care Physicians ◽

Weight Changes ◽

Initial Weight ◽

Initial Weight Loss ◽

Care Appointment ◽

Primary Care Appointment

Abstract Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.

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Comment on: a pilot study of primary care physicians’ attitude to weight loss surgery in England: are the young more prejudiced?

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2018.01.003 ◽

2018 ◽

Vol 14 (3) ◽

pp. 380-381

Author(s):

Richard M. Peterson

Keyword(s):

Primary Care ◽

Weight Loss ◽

Pilot Study ◽

Primary Care Physicians ◽

Weight Loss Surgery

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Abstract P217: Dietary Habits Associated With 6- and 24-month Weight Loss Maintenance in Primary Care Patients

Circulation ◽

10.1161/circ.137.suppl_1.p217 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Bethany Barone Gibbs ◽

Dana Tudorascu ◽

Cindy Bryce ◽

Diane Comer ◽

Gary Fischer ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Weight Gain ◽

Primary Care Physicians ◽

Weight Regain ◽

Dietary Habits ◽

Weight Loss Maintenance ◽

Fried Foods ◽

Primary Care Patients ◽

Diet Habits

Introduction: Though weight loss can improve health, weight regain is common. Primary care physicians are uniquely positioned to provide counseling for weight loss maintenance given their longitudinal care of patients, yet evidence of simple lifestyle recommendations for maintaining weight loss in primary care patients is lacking. Our objective was to characterize longitudinal associations between diet habits and weight change among primary care patients with recent, intentional weight loss of at least 5%. Methods: This was a secondary analysis of data from a weight loss maintenance clinical trial in a primary care setting that compared two interventions delivered through the electronic health record: continued coaching vs. tracking only. Dietary habits [fried foods, desserts, fruits and vegetables (F&V), and sugar-sweetened beverages (SSB)] were measured by the Connor Diet Habits Survey. Linear regression models were used to evaluate associations (overall and by randomized group) between changes in dietary habits and weight separately at 6- and 24-month follow-up, adjusted for baseline diet habit, age, gender and clinic location. Results: Participants (n=192) were 74% female, 87% white and had baseline mean (SD) age of 53 (12) years, body mass index of 30.4 (5.9) kg/m 2 , and recent weight loss of 11 (8) percent. Overall, participants had mean (SD) weight loss of 0.18 (5.04) kg at 6 months (n=169) and weight gain of 3.26 (7.60) kg at 24 months (n=140). At 6 months, a 1 serving per week increase in dessert intake was associated with 0.53 kg (p=0.030) greater weight gain. Fried foods, F&V, and SSB were not associated with 6-month weight changes. However, by 24 months, an increase of 1 serving per week was associated with greater weight gain of 0.54 kg (p=0.043) for fried foods, 0.80 kg (p=0.031) for desserts, and 2.01 kg (p=0.002) for SSB. A decrease of 1 F&V serving per day was associated with a 0.82 kg (p=0.008) greater weight gain at 24 months. When stratified by randomized group, associations were stronger in the continued coaching vs. tracking only arm. Conclusions: Increased consumption of desserts was associated with weight regain at 6 and 24 months, while increased fried foods and SSB, and decreased F&V were associated with weight regain at 24 months. These data suggest that simple strategies such as improving or at least maintaining dietary intake of fried foods, desserts, F&V, and SSB could help facilitate long-term weight loss maintenance in primary care patients.

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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