- psychologists (who ironically have provided the bulk of the research regarding the benefits of intensive behavioral therapy for obesity)
- mental/behavioral health providers, social workers, counselors and specialists
- exercise specialists, exercise physiologists, exercise therapists and exercise scientists
- diabetes nurse educators and other nurses
- board certified behavioral analysts
- preventive medicine specialists
- athletic trainers, appropriately certified personal trainers, kinesiologists, sports medicine physicians
- academically prepared professionals with specialized experience in obesity
- occupational therapists
- bariatric surgeons, bariatricians, obesity medicine specialists, bariatric medicine specialists
- trained non-clinical providers, lay providers, peer health educators
- PhDs, surgeons, physicians, cardiologists
- commercial weight loss programs
That’s a formidable list, some with dubious credentials to “treat obesity.” No wonder CMS puts the brakes on. The irony in all of this is that studies show medical students are poorly prepared to treat obesity. Efforts are already attempting to help physicians in practice to become effective. But with 7-8 minutes per patient visit, how effective can these primary care doctors become? As for the nurses and physician assistants, I’m not sure that they have the skill set either.
How many allied health care professionals take more than a single class in nutrition? How many of them understand the role of exercise and metabolism? How many of them have the time and know how to work with the complex behavioral changes involved with purchasing and preparing food as well as navigating an increasingly abundant and adulterated food supply. Too many clinicians tell patients that they need to lose weight. Six months later and a few may be surprised, others may be disappointed, and too many basically give up when little has changed.
Counseling to improve metabolic health is not as simple as prescribing medication. Current paradigms put too much focus on the outcome of weight loss. The process often gets inadequate attention. Throughout the process a patient benefits from an opportunity to assess their personal readiness, willingness and ability to achieve stated goals. They have an opportunity to figure out what approach to food works for them. The resistant patient often needs a lot more support to navigate any one of these arenas.
In the end, my guess is there will be few individuals who will be able or willing to pay out of pocket to see a dietitian or other practitioner in private practice if the services are readily covered if they are performed in a physician’s office. Will primary care providers make adequate professional resources available “in house”?
CMS MISSES THE MARK