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February 2013

Why are Fewer Physicians Offering Weight Counseling to Overweight Patients?

Despite the fact that more and more Americans are obese or overweight, fewer physicians are offering weight-loss counseling to their patients, highlighting a growing need for qualified health coaches to fill the void. 

By now it’s no secret that more Americans than ever before—145 million, in fact—are overweight or obese. And yet new research suggests that today fewer primary care physicians are offering weight counseling to their patients, especially those with high blood pressure and diabetes, compared to the mid-1990s. 

Penn State College of Medicine researchers analyzed data from the National Ambulatory Medical Care Survey for the years 1995–1996 and 2007–2008. This national survey collects information about the provision and use of outpatient medical care services in the United States. The 2007–2008 data was the most recent available at the time of the study, and the two time periods were chosen because the survey structure was similar, allowing for better comparisons. Their findings were published in the journal Medical Care.

Despite the current obesity epidemic, patients seen in 2007–2008 were 46 percent less likely to receive weight counseling, with counseling occurring in only 6.2 percent of visits in that year. At the same time, the percentage of adults who were overweight or obese increased from 52.1 percent in 1995 to 63.3 percent in 2008.

“It is striking that the odds of weight-loss counseling declined by 41 percent, with only 29.9 percent of obese patients receiving counseling in 2007–2008, given the substantial increases in the rates of overweight and obesity during that time,” says Dr. Jennifer Kraschnewski, an assistant professor of medicine. In addition, patients with high blood pressure were 46 percent less likely to receive counseling, and diabetes patients were 59 percent less likely. “People with these conditions stand the most to gain from the weight counseling,” Kraschnewski said.

Many Physicians Not Heeding Task Force Recommendations

In 2003, the U.S. Preventive Services Task Force recommended that physicians screen all patients for obesity and offer counseling and interventions to promote sustained weight loss. Created in 1984, the task force makes evidence-based recommendations about preventive services, including screenings and counseling.

Researchers aren’t entirely clear on the reasons behind the significant drop in weight-related counseling from physicians, but highlight barriers such as time limitations during appointments and doctors thinking that their training for lifestyle counseling is inadequate.

Other reasons may be that counseling services are not reimbursed, the researchers said, or that as physicians see rising rates of obesity among their patients, they offer less counseling because of a perceived lack of success.

Kraschnewski said the lack of response to the obesity epidemic by primary care providers is a missed opportunity.

“Unfortunately, other studies have [also] shown that physicians do not conduct weight and weight-related counseling for the majority of their affected patients,” Kraschnewski said. Evidence shows, however, that counseling can help adults lose weight and keep it off, which underscores the importance of qualified health coaches in helping to reach those who aren’t receiving the necessary counseling from their physicians.

"Given the enormous amount of attention currently given to the obesity epidemic and healthcare crisis, certified health coaches can play a vital role on the allied health continuum," says Dr. Cedric X. Bryant, ACE Chief Science Officer. "They are well trained and uniquely qualified to serve as an important communication bridge betwen busy, overworked physicians and their patients who are often afraid to ask them questions." In other words, certified health coaches can help fill the health and fitness information gap that currently exists between physicians and patients (as highlighted by this study). After all, as Bryant explains, certified health coaches can provide essential education and programming in the areas of nutrtition, physical activity and lifestyle behavioral change, all of which can have a positive impact on addressing health issues like diabetes and high blood pressure. 

Does Insurance Cover the Cost of Health Coaching Services?

In an effort to address the extraordinary morbidity and expense of obesity, in December 2011, the Centers for Medicare & Medicaid Services authorized reimbursement for physician-led* intensive obesity counseling to include weekly face-to-face meetings for the first month, followed by monthly meetings for the remaining 11 months, provided the patient demonstrates a 3kg (6.6 pounds) weight loss in the first six months of treatment. In June 2012, the U.S. Preventive Services Task Force recommended intensive obesity therapy, signaling a call to other health insurance programs to cover these services. In most cases, services can be administered by a non-physician under the leadership of a physician, but other allied health professionals such as registered dietitians, psychologists, and exercise specialists cannot independently bill for services.

*physician-led also includes nurse practitioners and physician assistants


Kraschnewski, J.L. et al. (2012). A silent response to the obesity epidemic. Medical Care, DOI: 10.1097/MLR.0b013e3182726c33

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