Primary Care Physicians
As a chronic condition, obesity, like type 2 diabetes, hypertension, high cholesterol, can and perhaps should be managed in the primary care setting. However, there is wide variability in the level of formal obesity management training for primary care physicians (PCPs). Additionally, significant clinician time is generally spent on near-term priorities such as management of chronic conditions to achieve target treatment goals (a central focus for care management and clinician revenue generation). The PCP management of patients who are overweight or have obesity should include the following:
- Calculate a Body Mass Index (BMI) and code obesity as a diagnosis.
- Address and treat any risk factors for heart disease and obesity-related comorbidities.
- Screen for symptoms of depression and other mental health issues; consider referral to behavioral health clinician with expertise in weight management and depression.
- Develop and implement a treatment plan that includes dietary guidelines, an exercise regimen that is appropriate given the risk factors, and refer to a registered dietitian, as appropriate.
- Consider referral to weight management programs, such as those provided by an employer or available in the community.
- Establish regular follow-up visits to determine if the patient is achieving success (3% to 5% weight loss) and if not, consider referral to a board-certified obesity medicine specialist.
Obesity & Weight Loss Specialists
Alternatively, physician-led weight management centers can offer holistic treatment through a multi-disciplinary approach and include treatment and consultation of nutritionists, nurse practitioners and behavioral psychologists.
Centers of Excellence (COE)
COEs are typically located within health care institutions. They offer programs with a high level of expertise in a particular area of medicine focused on the best possible outcomes and fewer complications for patients. Common specialty areas include oncology, cardiology, orthopedics and bariatric surgery, and may also include comprehensive weight management programs.
Facilities that are accredited as COEs for bariatric surgery support continuous quality improvement by implementing defined standards of care, documenting outcomes and participating in regular reviews to evaluate their bariatric surgical programs. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program accredits inpatient and outpatient bariatric surgery centers in the U.S. that have undergone an independent, voluntary peer evaluation in accordance with nationally recognized bariatric surgical standards.