Waiting to Close the Gap in Primary Care of Obesity

We are waiting, but we should not. A tremendous gap in care for obesity stands open. It is the gap between primary care for obesity that people need and an uncomfortable silence that persists – at best. Because right now, if the silence is broken, most often patients receive only vague advice to lose weight. But the fact is that the minimum effective intervention is intensive. So it rarely happens in primary care.

The latest effort to close this gap comes in the form of the Weight Can’t Wait guide from George Washington University.

A Productive Start

This guide is the product of a long intensive process of its own. Multiple professional groups participated to identify sound ways for primary care providers to begin addressing the need.

In the end, it’s relatively simple. A primary care provider can make a difference if they meet the patient on their own terms. That means to start with an understanding of how obesity might be influencing a patient’s health. Then, asking the patient if this is a good time to discuss how these factors are influencing each other. From there, the process flows for follow-up care or referral that will meet individual needs. One-size-fits-all advice to lose weight is worse than useless. Most often, it’s harmful.

Rare Consensus

In developing this new guide, the STOP Obesity Alliance at George Washington has built a level of consensus that’s rare. Diverse organizations ranging from the American College of Physicians to the Obesity Society and the Obesity Action Coalition are all supporting it.

The reason is simple. The need is great and the principles for getting started are clear. The challenge comes in the doing. Like all of us, providers have strong implicit biases about the causes and the solutions to obesity. If only people would change their ways … is how the flawed thinking goes.

But the truth is that the causes of obesity are complex and very different in different people. Often, it develops over a lifetime and it takes time and care to make a clinical difference. So boilerplate advice isn’t helpful.

The Weight Can’t Wait guide provides a useful map for getting started on a better path to care.

Click here for the guide and a wealth of resources. For further perspective on primary care for obesity, click here, here, and here.

The Clinic of Doctor Macaire, hand colored lithograph by Honore Daumier / WikiArt

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November 24, 2020