You may notice something new when you go to your doctor. He or she may actually talk to you about your weight and for the first time you might hear evidenced-based guidance on weight loss. Health care providers participating in Accountable Care Organizations (ACO) will be measuring height and weight on their ACO patients, assessing Body Mass Index (BMI) and providing a plan for those identified as being outside the normal BMI parameters. Body Mass Index (BMI) is one way to tell whether you are at a healthy weight, overweight, or obese. It measures your weight in relation to your height.
A BMI of 18.5 to 24.9 is in the healthy range. A person with a BMI of 25 to 29.9 is considered overweight, and someone with a BMI of 30 or greater is considered obese. BMI is used for children but the cut-off points are not the same. Assessing BMI is important because a high BMI increases the risk for type 2 diabetes, heart disease and stroke, high blood cholesterol, high blood pressure, kidney disease, non-alcoholic fatty liver disease (a fat buildup in the livers of people who drink little or no alcohol) and certain cancers.
Most Americans visit their doctor once per year but less than half of obese patients report being advised to lose weight. The doctor that addresses weight and nutrition could do a lot to balance the millions of dollars spent to promote obesiogenic foods and fad diets that only lead to yoyo dieting and weight regain.
Doctors have been checking height and weight as part of patient care and physicals but now because of ACO’s, they will need to provide ACO patients with a treatment plan and document that they did it. I believe it is the treatment plan that has the potential to generate a thoughtful discussion about losing weight.
One of the most powerful pieces of information a health care provider can share with patients trying to lose weight, is to tell them exactly how many calories they need to lose weight. In November 2013 the American Heart Association, American College of Cardiology and the Obesity Society published Clinical Practice Guidelines to guide healthcare providers in treating obesity. To lose weight the report recommends we cut calorie intake by 500 to 750 daily. Most men can lose weight on a 1,500-1,800 calories daily. Women can lose weight on a calorie level between 1,200-1,500 per day. It might surprise you, but many people do not know how many calories they need to lose weight and they often think it is more complicated than just portion control. The report finds any diet can work if it reduces total calories. Of course the best diet reduces calories and includes health promoting foods such as fruit and vegetables, poultry over beef , whole grains over refined breads and pastry, and meals that include fish, nuts and beans. The Harvard School of Public Health web page www.nutritionsource.org is an excellent resource for information about food and nutrition, this is my personal recommendation not the ACC/AHA.
I have years of anecdotal reports from patients who appreciated hearing weight loss guidance from their doctor – but lets turn to the research. A meta analysis published in the International Journal of Obesity reviewed the published data on 32 studies a examining the impact a health care provider can have on weight loss and found advice on weight loss had a significant impact on a patients attempt to lose weight. Identifying the problem is the first step, the next step is to provide evidence based solutions . Writing in the Journal of Continuing Education authors Fruh and Flkerson found individuals are often unaware of what it takes to lose weight, and health care providers can promote an understanding of calories and help patients make healthful food choices.
In short, the ACO is asking doctors to address an issue that for far too long has been left to the free market. Most of us obtain our weight loss advice from magazines, books, and supplement companies that profit from the confusion and ignorance that surrounds losing weight. This approach has not been good, and the rise in obesity has been significant.
The ACO is pushing the health care system to deal with the problem of obesity in only a select number of patients, I am hopeful discussions and weight loss plans will trickle down to all patients. In my own practice, primary care providers are asking for simple resources such as: What is BMI to address the issue. I suspect many more primary care providers will be looking for tools to address the issue, and attending conference about the management and treatment of obesity. I am very hopeful that the end result will be an intelligent and thoughtful discussion between patient and provider about what it takes to lose weight, with the needs of the patient kept in front and the advice based on science.