Friday, April 15, 2011

Will Primary Care Physicians Counsel More Obese Patients to Get Bariatric Surgery?

It’s been said that primary care physicians don’t counsel their patients on overweight and obesity enough. However, many believe that if physicians told their patients that they needed to lose weight the patients would take some action. But according to a survey referenced in USAToday, less than 50 percent of physicians discuss weight with their patients.

There are a number of reasons physicians don't discuss weight with their patients. One of the reasons given is a lack of appropriate skills on the physicians' part. Another is the lack of faith that an overweight or obese patient will do what's recommended. For these and other reasons, one has to wonder if more primary care physicians might find it easier to just refer an obese patient to a bariatric surgeon rather than trying to treat the patient's obesity.

According to a recent article in The Sunday Times, a study done in Ireland by the Trinity College Centre for Health Sciences, showed that “42% of GP practices in Dublin have referred patients for bariatric surgery.” Seventy five percent of the physicians prescribed weight loss medications, and 35% or less of the Irish GPs referred an overweight patient to a dietitian. The reasons the GPs gave for this practice were constraints on time and “limited access to a dietitian.”

One expert, quoted in the article, did agree that medications and bariatric surgery were overused. But he suggested that prescribing diet and exercise was useless because the practice did not lead to successful weight loss.

With the loosening of lap band surgical guidelines by the US FDA , we can speculate that more US primary care physicians might start counseling their patients to lose weight using surgery, rather than diet and exercise. In a lot of cases, weight loss surgery is the most appropriate weight loss method. But there are many cases where the combination of diet, exercise, and lifestyle modification is the best approach.

Primary care physicians should get the appropriate weight loss training. These physicians should be given the time to adequately counsel overweight and obese patients. And the physicians should be reimbursed for their time. Since most patients do listen to their physicians, intensive counseling may encourage a patient to dutifully follow a non surgical weight loss program -- at least until there is no doubt that the program is failing. Indeed, all weight loss approaches have a place in the fight. Therefore, health care providers should be equipped to help the patient decide when a specific weight loss approach is the right choice.

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