Manage Patient Obesity and Meet Pay-for-Performance Goals

Houston - or should I say America -we have a problem. Although Texas' most populous city has long held a reputation as home to the most obese population per capita, when we look at the bigger picture, we see that the Lone Star State is in fact, not alone. The nationwide statistics are staggering: in 2013, 69 percent of US adults over the age of 20 were overweight or obese, according to the CDC. The same year, the AMA officially labeled obesity as a disease.  

As a cardiologist, I'm committed to helping my patients avoid the long-term and often fatal consequences of obesity, including hypertension, diabetes, heart disease, and stroke. Primary-care physicians and practitioners are also on the frontlines in the struggle against obesity. However, it's clear the tried and tried again diet-and-exercise prescription is not working.

It's critical that physicians and specialists lead the fight against obesity. Yes, it's difficult. Traditionally we have not had the time, skill set, or resources to support our patients on their challenging journey. However, there are some simple steps you can take to better engage your overweight patients, improve patient wellness, measurably improve population health, and - at the same time - positively impact the bottom line of your practice.

1. Conversation
If you have patients who would benefit from losing weight, talk to them about it. Although this may seem like a no-brainer, one-third of patients who are obese report that they have not been told that they are overweight by their physician, according to a Journal of Community Health report. Reimbursement is now available for initiating obesity dialogue with the introduction of obesity screening and counseling for Medicare patients with a body mass index (BMI) of 30 or more.

2. Education
A study in The Lancet found that there is a lack of emphasis on nutrition counseling by physicians of obese patients, and increased emphasis on exercise, despite the fact that nutrition is actually more effective for weight loss. Additionally, patients should be educated in the chemical composition of their diets and the roles that insulin and pancreatic dysfunction play in obesity-related issues, as well as supported with tools to help them evaluate and address their diet.

3. Structure
Simply telling patients that they need to lose weight is not enough. I am a formerly obese patient: I tried dieting and exercise, but it's not that simple. Losing weight - and more importantly keeping the weight off - is difficult. Repeatable and sustainable weight loss programs that provide tools to help doctors recommend weight loss, as well as motivate and manage the patient to meet their weight loss goals are needed for successful, long-term weight loss.

4. Evaluation
Aside from being repeatable and sustainable, structured weight loss programs are measurable. We can document the success and objectively evaluate the quality of these programs through patients' lab results. Positive lab results help improve population health management and better prepare your practice to respond to pay-for-performance initiatives.

If physicians can support overweight and obese patients with the tools they need - conversation, education, structure, and evaluation - through repeatable and sustainable weight loss programs, we can truly help patients to achieve long-term, positive effects on their health and well being and help our practices thrive in the pay-for-performance environment, as well.

Douglas Rothrock, MD, is a board-certified cardiologist practicing in Prescott, Ariz., and the senior medical advisor for Ideal Protein®, a physician-developed weight loss method. He can be contacted at dougandnancyrothrock@gmail.com.