Obesity Counseling to be Paid for by Medicare

Recently I have become interested in the obesity epidemic plaguing our country. I’ve actually been interested in obesity and co-morbid psychiatric illness since residency, but recently my interest has been revived. I read that Medicare is going to be reimbursing health care practitioners for obesity counseling and screening. My initial thought was that this is a positive step in the right direction. But the cynic in me began to wonder–what does obesity counseling exactly consist of? Who will be administering this counseling? Will it be nurses, doctors, nutritionists, or psychologists? What data is available that tells us this will actually work?

Currently, the art of “counseling” is already in danger of becoming an extinct entity, as a result of changing insurance reimbursements, which tend to be better for psychiatrists who prescribe medications rather than psychotherapy. This has influenced the state of psychiatry training programs, which have begun to deemphasize training for therapy, favoring instead a focus on psychopharmacology and biology. This has its pros and cons, as with anything, but has turned psychiatrists partially into pharmacists. I find it unfortunate.

But back to obesity counseling. Usually now, when obese patients see their doctors, they hear a lot of the same information over and over again–that obesity leads to hypertension, diabetes, strokes, heart attacks, shorter life expectancy, and so on. To deal with obesity, patients are told to eat healthier and to start exercising. Well, no kidding! All of this information is now readily available anywhere online and is not news to people. So what makes doctors think that repeating this information will all of a sudden get a patient to lose weight? It doesn’t. Which leads to no change, which in the long run, makes doctors become pessimistic, believing none of their patients will change. So they start treating the diabetes and high blood pressure, ignoring the underlying obesity, and it turns into one big never-ending cycle.

I hope this is not what “obesity counseling” will consist of. I hope that what doctors and other health care practitioners start learning is that motivational interviewing and motivational therapy is the way to get patients to start changing. We have to allow patients to tell us why they want to change, not us tell them why they need to. People only change when they are ready to. We need to start learning how to get patients to get closer to that point. It’s easier said than done.

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5 Comments on “Obesity Counseling to be Paid for by Medicare”

  1. Mad_scientist79 Says:

    I completely agree… we’ve made Motivational interviewing a key component at our Residency program, and we’ve noticed a wonderful improvement in patient satisfaction (and results)… When you meet a patient where they are at, and work with them to achieve those small incremental goals, at their pace, good things happen.

    • Dr. G Says:

      That’s great to hear! I learned it in residency but never used it much, starting to use it more now. Are you in a psychiatry residency or another specialty?

      • Mad_scientist79 Says:

        Indeed it is! I am actually in a Family Medicine residency program (UTMB)… I am not sure about the extent of use of MI in our Psychiatry residency program (although I’ll find out during a future elective). As for MI, I think that its a skill that can be used in every clinical encounter. It would be great if all physicians received some MI training during their residency…

  2. SK Says:

    You are absolutely correct! My husband (of 40 years) has always been big. He has been on every weight loss program, meal plan, hypnosis, shots there is (yielding the yo-yo syndrome of repetitively losing/gaining). We have over the years gone on and have all the diet books. Also, just as you say, Family doctor has done “motivational” talks over all these years and even prescribed diet med–all to no avail. The behavior returns and it is so sad to see your loved one’s efforts be in vain. How heart-breaking seeing his repeated frustration and depression. Needless to say, my husband has now diabetes, sleep apnea, mobility loss, and strives to keep weight below 375. This should be our “wonderful” retire years. Sadly, almost each day I see my dearest friend and loved one continue in a self-destruct mode, perhaps witnessing the plague or murderer– this uncontrollable behavior. Private treatment centers are not an option for our budget. Please forward any books, articles, or other literature that may help.

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