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• W2034896661 abstract "HomeCirculationVol. 124, No. 10New and Emerging Weight Management Strategies for Busy Ambulatory Settings Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBNew and Emerging Weight Management Strategies for Busy Ambulatory SettingsA Scientific Statement From the American Heart Association Goutham Rao, MD,, Lora E. Burke, PhD, MPH, FAHA, Bonnie J. Spring, PhD, Linda J. Ewing, PhD, Melanie Turk, PhD, RN, Alice H. Lichtenstein, DSc, FAHA, Marc-Andre Cornier, MD, J. David Spence, MD, FAHA, Michael Coons, PhD and on behalf of the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Clinical Cardiology, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, and Stroke Council Goutham RaoGoutham Rao Search for more papers by this author , Lora E. BurkeLora E. Burke Search for more papers by this author , Bonnie J. SpringBonnie J. Spring Search for more papers by this author , Linda J. EwingLinda J. Ewing Search for more papers by this author , Melanie TurkMelanie Turk Search for more papers by this author , Alice H. LichtensteinAlice H. Lichtenstein Search for more papers by this author , Marc-Andre CornierMarc-Andre Cornier Search for more papers by this author , J. David SpenceJ. David Spence Search for more papers by this author , Michael CoonsMichael Coons Search for more papers by this author and on behalf of the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Clinical Cardiology, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, and Stroke Council Search for more papers by this author Originally published8 Aug 2011https://doi.org/10.1161/CIR.0b013e31822b9543Circulation. 2011;124:1182–1203Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 IntroductionRecent data from the Centers for Disease Control and Prevention show that a staggering 68% of American adults are either overweight or obese, and 34% are obese.1 Although there is evidence that its prevalence is stabilizing, obesity remains an extremely serious public health problem. It is a major risk factor for a wide range of medical (eg, type 2 diabetes mellitus), social (eg, discrimination in employment and education settings), and psychological (eg, depression) conditions.2Although the effectiveness of different obesity treatments has been evaluated systematically,3 rational, safe, and effective treatments from which the majority of overweight and obese patients can benefit remain elusive. New medications are emerging, but their impact on weight loss has been modest, and their long-term adverse effects are uncertain.4 Bariatric surgery is effective but expensive and is appropriate only for a small proportion of patients in whom the benefits outweigh the risks. Effective and safe commercial and noncommercial behavior modification programs are scarce. Changes in public policy and the “built environment”5 may curb obesity, but such changes take a long time to bring about, and the magnitude of their impact has yet to be established clearly. A recent review, for example, concluded that soft drink taxes have only a small impact on a population's average body mass index (BMI).6It is widely acknowledged that no single strategy will solve the obesity problem and that effective public health initiatives to prevent and treat obesity will require the involvement of multiple stakeholders, including patients, employers, health plans, governments at all levels, the food and beverage industries, and healthcare providers.7,8 Among these healthcare providers are those who deliver care in busy ambulatory settings, including primary care physicians, nurse practitioners, nurses, registered dietitians, and others. Screening and counseling for obesity in such settings is widely recommended.9,10 Unfortunately, there is ample evidence that physicians and other healthcare professionals are poorly equipped to tackle the problem. A survey conducted in 2006 revealed, for example, that only 65% of obese patients were advised to lose weight by their physicians.11 A lack of knowledge, skills, and practical tools have all been identified repeatedly as barriers to the identification and management of obesity by healthcare professionals.12–14The purpose of this statement is to provide an overview of new and emerging tools and strategies for discussing weight and assisting overweight and obese patients. Only tools and strategies that can be used practically in busy ambulatory settings are included. The goal is to provide clinicians with evidence-based strategies to tackle the problem of obesity in settings in which patients are seen for a wide variety of problems. Before using such strategies, of course, it is important to assess patients for overweight and obesity, a critical step that is addressed in another pending American Heart Association scientific statement on assessment of adiposity.14a On the basis of our literature review, we have divided strategies into 3 categories: (1) appropriate ways of discussing body weight with patients (including readiness to change); (2) approaches that involve multidisciplinary collaboration among healthcare professionals; and (3) strategies that make use of information technology to deliver weight management programs. Although many weight management approaches that make use of technology have not been evaluated in busy ambulatory settings, we believe technological approaches should be included in the present statement because they have the potential to impact large numbers of participants and are relatively easy to recommend, administer, or refer to in such settings.1. Discussing Weight With PatientsOverviewThis section includes a review of existing evidence about (1) acceptable methods for raising and discussing the issue of weight, (2) practical methods of assessing readiness to change and motivation for attaining a healthier weight, and (3) practical strategies for assessment of eating and physical activity behaviors in busy settings.Search StrategyWe searched for articles that explicitly described strategies for discussing weight with patients. Search terms including “physician-patient relations” OR “primary care” etc AND “communication” OR “counseling” etc were used in combination with “obesity” OR “weight loss” to identify relevant studies in the following databases: PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the New York Academy of Medicine Grey Literature Collection. We searched only for reports published from 2002 through November 2010.ResultsWe retrieved 157 unique citations from PubMed and 59 from EMBASE, with no other unique citations indentified in the other databases. The vast majority of these reports were not relevant. Citations not reviewed included descriptive studies of the perspectives and practices of providers (eg, perceived barriers to weight management in primary care, patients' recall about receiving weight management advice). Other reports not reviewed described strategies for discussing weight that we considered too time consuming and impractical for busy clinical settings. We reviewed 23 reports in depth (Table 1).Table 1. Studies Included in Section 1: Discussing Weight With PatientsStudy/Design/DescriptionSampleIndependent VariablesOutcome MeasuresResults for Assessment, Discussing Weight or Readiness to ChangeBlixen et al, 200615Descriptive survey to examine perceptions of obesity and weight-management preference among black and white general internal medicine female clinic patientsN=480 Surveys mailed: 240 to white and 240 to black female patients; 256 surveys returned (55% response rate); only blacks and whites included in the study (n=229) 100% Female 36% White 54% Black 11% Other Age: 51.5±14.1 y (white); 49.8±14.9 y (black) BMI 37.6±7.9 kg/m2 (white); 42.2±9.4 kg/m2 (black) All with ICD-9 diagnosis of obesityBlack and white races18-Item questionnaire developed from 5 themes that arose from focus group data: (1) perceptions and attitudes about weight;(2) aspects of life that weight affects;(3) weight associated medical knowledge;(4) past weight loss attempts and associated factors; and(5) help with losing weight that women want from their PCPCompared with white women, black women expressed a greater need for a physician's help with weight loss strategies in the following areas: One-on-one assistance from PCP (P<0.001); group meeting with PCP, dietician, and other women (P=0.007); referral from PCP to dietician (P=0.031); prescribe medication for weight loss (P=0.006); individual counseling by PCP (P=0.015); take part in weight loss classes in PCP's practice (P=0.011); PCP to review adverse outcomes and dangers of weight gain (P<0.001); and PCP to firmly discuss need for weight loss (P<0.003).Bolognesi et al, 200616RCT to examine the effect of a GP-administered physical activity counseling intervention on BMI, waist circumference, and physical activity stage of changeUsual-care control group n=55 (48 completed); PACE intervention group n=55 (48 completed) 72.9% Age 41–70 y 53.1% Female 83.3% Married All were overweight or obese patients from 8 practices in Emilia Romagna, Italy, for whom physical activity was not contraindicated.Intervention group: PACE protocol for physical activity counseling included a baseline assessment of stage of change followed by a standard procedure for the stage that required 2–5 min of interaction between GP and patient. A 2- to 3-wk follow-up via mail or telephone reinforced the stage-specific themes of the protocol. Usual-care control group: general discussion and recommendations for a healthy lifestyle provided by GP for 2–5 minBMI: change (in kg/m2) at 5- to 6-mo follow-up Waist circumference: change (in cm) at 5- to 6-mo follow-up Stage of change for physical activity: change in stage level self-reported by intervention group as their stage of readiness for physical activity during leisure timeANCOVA analyses that controlled for baseline BMI and waist circumference revealed a significant difference between the intervention and control groups at 5- to 6-mo follow-up; the intervention group decreased in BMI and waist circumference, whereas the control group increased in both (P<0.01). Within the intervention group, 60% of precontemplators moved to contemplation or preparation at follow-up; 51.4% who were contemplators or preparers at baseline moved to action or maintenance stage.Boudreaux et al, 200317Cross-sectional descriptive study to investigate relationships of decisional balance and self-efficacy with stage of change for avoiding dietary fat and engaging in exercise regularlyN=515 Adult patients in 4 public primary care clinics 60% Black 81% Women 43% Married 71% Uninsured Age 45±14 y Monthly household income: $490±$453Exercise self-efficacy: 5-item, 5-point Likert scale (1=not at all confident to 5=extremely confident) assessing confidence in ability to exercise in various circumstances Exercise decisional balance: 16-item, 5-point Likert scale (1=not important to 5=extremely important) assessing the degree of positive or negative feelings derived from exercise Dietary fat self-efficacy: 12-item tool assessing confidence for avoiding dietary fat on a 5-point Likert scale (1=not at all likely to 5=extremely likely) Dietary fat decisional balance: 8-item, 5-point Likert scale (1=not important to 5=extremely important) assessing the degree of positive or negative feelings derived from reducing dietary fatReadiness to exercise: classified as precontemplation, contemplation, preparation, action, or maintenance for engaging in and maintaining a regular exercise routine (on a weekly basis, at least 3 exercise sessions of ≥20 min) Readiness to decrease dietary fat: classified as precontemplation, contemplation, preparation, action, or maintenance in response to question, “Do you consistently avoid eating high fat foods?” Followed up with 5 yes/no questions about actual low- or no-fat eating behaviors.Stage of change for avoiding dietary fat was significantly related to stage of change for exercise; P<0.001. 27.4% of the study population was stage congruent for exercise and avoiding dietary fat; 37.3% was 1 stage apart (eg, contemplation for dietary fat, preparation for exercise); 35.3% was >1 stage apart (eg, precontemplation for dietary fat, preparation for exercise). The majority of the sample was stage incongruent, which suggests that intervention efforts of providers should be tailored to the stage of change for each behavior.Brown et al, 200618Qualitative study using semistructured interviews to explore the experiences and perceptions of support among obese primary care patientsN=28 Adult patients from 5 general medicine practices in Sheffield, United Kingdom Mean age 56 y (range 19–77 y) Mean BMI 35.6 kg/m2 (range 29.4–61.5 kg/m2) Female 64%N/AExperiences and perceptions of obese patients related to support and careThemes emerged about level of support for weight loss, with disappointment related to being told about the need to lose weight with no practical advice or support for how to do so. Patients expressed dissatisfaction with hurried office visits that provided limited resources for weight loss efforts and desired specific support services that were available through their practitioner's office.Counterweight Project Team, 200819Prospective assessment of a comprehensive program to manage obesity in primary care practices65 General medical practices from 7 regions in the United Kingdom agreed to participate; 56 participated N=1906 patients enrolled n=1419 at 12-mo follow-up n=825 at 24-mo follow-up Age 49.4±13.5 y BMI 37.1±6.9 kg/m2 Female 77%Intervention: registered dieticians trained GPs and PNs on screening and treatment pathways for Counterweight program. PNs delivered the patient education and intervention based on patients' stage of readiness to lose weight. Those in contemplation or action stages were asked to participate. Patients who were not ready to change were given information about the health benefits of 5%–10% weight loss and advised to think about weight loss. Patients committed to 9 appointments over 12 mo.Primary outcomes: weight change at 12 and 24 mo Percentage of patients losing and maintaining ≥5% at 12 and 24 moMean 12-mo weight change for 642 attendees: −2.96 kg (95% CI −3.47 to −2.44) 30.7% of attendees maintained ≥5% weight loss Mean 24-mo weight change for 357 attendees: −2.3 kg (95% CI −3.2 to 1.4) 31.9% of attendees maintained ≥5% weight lossGreenwood et al, 200820Pilot and cross-sectional studies to develop and assess an eating behavior clinical screening tool for use with primary care patientsPhase 1 (pilot) N=48 adult patients from 2 family medicine clinics in the Utah Health Research NetworkAge 42.6±12.1 yFemale 54%White 77%Phase 2 (cross-sectional)N=261 adult patients from same 2 family medicine clinicsAge 38.4±11.7 yFemale 58%White 80%Education 15.7±3.4 yBMI 27.7±7.2 kg/m2Phase 1: Two versions of screening questionnaire for physical activity and eating behaviors of consumption of restaurant food, large portion sizes, sugar-added beverages, fruits and vegetables, and breakfast Phase 2: BMI, overweight, obese status as factors related to reported eating behaviors; BMI objectively measured using weight in kilograms divided by height in meters squared: Overweight: 24.5 to 29.45 kg/m2 Obese: ≥29.5 kg/m2Phase 1: Participants' perceptions of the questions in terms of ease of understanding, response accuracy, and actual representativeness of the behavior Phase 2: Self-reported eating behaviors and physical activity from 14-item final version of the questionnairePhase 1: Reporting of behaviors from the previous day was said to be less representative of the behavior than reporting of typical behaviors over a period of time; final version had 14 questions about specific eating behaviors, including 1-d and 1-wk recall, as well as typical behavior. Phase 2: Each additional sugar-added beverage typically consumed in a day was associated with a 0.61-unit increase in BMI (P=0.006). Every 1-day increase in moderate physical activity was associated with a 0.91-unit decrease in BMI (P<0.001). The odds of being classified as obese were 1.47 higher (P=0.002) for each unit increase in the frequency of consuming a full-size portion of a restaurant meal compared with never consuming a full-size portion of a restaurant meal.Huang et al, 200421Cross-sectional, descriptive study using exit interviews to evaluate patients' recollection of physicians' recommendations for weight loss and the effect of MD weight loss counseling on patients' understanding of, motivation toward, and behaviors for weight lossN=210 convenience sample of adult primary care clinic patients with a BMI ≥25 kg/m2 for whom English was their first language Mean age 52 y (range 18–82 y) Mean BMI 39 kg/m2 (range 26–65 kg/m2) Female 74% Black 76% Insurance status: free care or self-pay 66%Analyses were adjusted for age, race, sex, and literacy levelTopics of patient interview questions: (1) understanding of association between weight and health(2) effect of 10% weight loss(3) specific weight loss advice of the MD(4) weight loss motivation(5) past and current weight loss efforts(6) readiness for weight loss79% recalled being advised to lose weight; of these, 28% recalled receiving specific recommendations for weight loss. 5% recalled being advised to combine dietary and exercise strategies for weight loss. Patients who recalled being counseled to lose weight were more likely to be in contemplation, preparation, action, or maintenance stages of change for weight loss (versus precontemplative stage) (χ2=19.24, P=0.001).Paxton et al, 201022Secondary data analysis to examine the feasibility, validity, and sensitivity to change of the STC brief dietary screening toolN=463 Age 58.4±9.2 y Female 49.8% White 72% BMI 38.4±6.5 kg/m2Analyses controlled for baseline age and Hispanic ethnicity8-Item STC tool compared with the NCI Percent Energy From Fat screener at baseline and 4 moIndividual STC items significantly correlated with summary score (r=0.39–0.59, P<0.05). STC summary score significantly correlated with NCI fat screener measurement of fat intake (r=0.39, P<0.05). STC summary score change significantly correlated with decrease in fat intake at 4 mo (r=0.22, P<0.05).Pollak et al, 200723Descriptive study of how weight loss is discussed between physicians and female family practice clinic patients who were overweight or obese using baseline surveys, audiotaped patient visits, and 1-mo follow-up surveysN=25 patients Age 59±11 y Female 100% White 50% BMI 37±11 kg/m2 N=7 physicians Age 43±10 y Female 57% White 57% BMI 22±3 kg/m2MI: Two coders evaluated MI strategies used by MDs for empathy, MI spirit, MI-adherent actions (MD advice given with patient permission, affirming and supportive statements emphasizing patient control), and MI-nonadherent actions (MD advice given without patient permission)Patient self-reported self-efficacy and readiness to lose weight immediately after office visit and at 1-mo follow-up. Patient self-reported attempts to lose weight by altering dietary intake, exercise habits, or both at 1-mo follow-up.Patients more likely to report changing their exercise habits at 1 mo when MDs displayed higher levels of empathy (r=0.50, P=0.02). Patients were more likely to report attempting to lose weight at 1 mo when MDs used more MI-adherent techniques (r=0.42, P=0.08).Simkin-Silverman et al, 200524Descriptive study of baseline data from the Primary Care Weight Control Project regarding the prevalence of previous MD-administered weight loss advice and predictors of identification of obese patients, as well as predictors of weight loss adviceN=255 adult patients Age 48.4±10.8 y Female 75.1% White 83.3% BMI 34.9±5.6 kg/m2 N=18 PCPs Age 38.1±5.5 y Female 61% White 72% BMI 34.9±5.6 kg/m2BMI (objectively measured) Waist circumference Level of physical activity Dietary intake Mood Readiness for weight management, dichotomized as precontemplation/contemplation and preparation/action/maintenance Percentage of previous office visits with PCP Medical history (patient self-report) Sociodemographic variablesPatient self-report of previous MD-administered weight loss advice Chart review of documentation indicating PCP had discussed weight or physical activity with patient Obesity diagnosis per chart reviewStage of change for weight control was a significant predictor of patient-reported, MD-administered weight loss advice (OR 0.36, 95% CI 0.15–0.88) and chart-documented, MD-administered weight loss advice (OR 0.37, 95% CI 0.20–0.69) in multivariate analyses.Segal-Isaacson et al, 200425Descriptive study to validate the REAP-S in combination with nutrition education for first-year medical students by correlating responses with the Block FFQN=110 First-year medical students Age 24.2±3.8 y Female 44% White 65% BMI 23.4±5.0 kg/m2Block 1998 FFQCorrelations of scores from REAP-S and Block FFQ on vegetable, fruit, dairy, added fat, and meat servings, as well as estimated nutrient intake on fiber, sugar, total fat, and cholesterolThe REAP-S was significantly correlated with all Block FFQ variables except (1) meat servings (P=0.51), (2) fiber intake associated with high-fiber starch and whole grain foods (P=0.08), and (3) total fat intake from fish, poultry, or meat (P=0.68).Scott et al, 200426Descriptive study:Obesity is epidemic in the United States and other industrialized countries and contributes significantly to population morbidity and mortality. PCPs see a substantial portion of the obese population, yet rarely counsel patients to lose weightWeight counseling (n=39) Adults >20 y: 12%Children ≥2 and ≤20 y: 8.2%Female 12.3%White 9.3%No weight counseling (n=337)Adults >20 y: 88%Children ≥2 and ≤20 y: 91.8%Female 87.7%White 90.7%Frequency of weight loss counseling in primary care visitsDescriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication about weight control in 633 encounters in family practices in a Midwestern state68% of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, whereas weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for the visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem.Jay et al, 200927Nonrandomized, wait-list/control design to assess the impact of an obesity counseling curriculum for residents: 5-hour multimodal obesity counseling curriculum based on the 5 A's (assess, advise, agree, assist, arrange) using didactics, role-playing, and standardized patientsControl group (n=74) Mean age 43.50±13.45 yFemale 73%Black 68%BMI 34.50±4.61 kg/m2 Intervention group (n=78) Mean age 46.11±13.73 yFemale 71%Black 78%BMI 33.83±3.86 kg/m2BMI, health status, and number of comorbidities of the patientPatient report of physician's use of the 5 A's was assessed by a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5 A's skills performed during the visit). Univariate statistics (t tests) were used to compare the rate and quality of counseling in the 2 resident groups. Logistic and linear regression were used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics.A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (>70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% versus 31.2% of 19 possible 5 A's counseling strategies, P=0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher-quality counseling than those in the control group (standardized β coefficient=0.18; R2 change=2.9%, P<0.05).Carels et al, 200528This investigation was designed to improve BWLP treatment outcomes by providing SC to individuals experiencing difficulties with weight loss during treatmentBWLP+SC (n=23) Female 85.2%White 92.9% BWLP only (n=23) Female 88.5%White 92.3%Weight, physical activity/fitness, and dietary intakeChanges in weight, cardiorespiratory fitness, self-reported physical activity, and diet (ie, calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP.Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (P<0.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (P<0.05).Heintze et al, 201029Cross-sectional study:The aim of this study was to assess GPs' and patients' practices and attitudes about overweight encountered during preventive counseling talksN=51 Age, y: 35–50: 21.1%51–60: 36.5%>75: 40.3% (1 patient w/no age specification) Female 17% BMI, kg/m2: 25.0–29.9: 38.5%30.0–34.9: 40.4%35.0–39.9: 13.7%>40: 5.8%N/ATwelve GPs audiotaped their preventive counseling talks with overweight patients, including the assessment of individual risk profiles and further medical recommendations. Fifty-two dialogues were transcribed and submitted for qualitative content analysis.Dietary advice and increased physical activity were discussed most often during talks. Recommendations appeared to be more individual if patients were given the chance to reflect on causes of their overweight during counseling talks.Burke et al, 20103024-mo RCT of behavioral intervention, examining effect of 3 approaches to SM on weight loss and SM adherenceN=210 PDA (n=68→64) 85.3% Women80.9 % WhiteAge 46.7±9.2 yBMI 34.9±4.6 kg/m294.1% Retention at 6 mo PDA plus daily FB (n=70→65) 84.3% Women78.6 % WhiteAge 46.4±9.5 yBMI 34.8±4.6 kg/m292.9% Retention at 6 mo Paper diary (n=72→63) 84.7% Women76.4 % WhiteAge 47.4±8.5 yBMI 33.4±4.5 kg/m287.5% Retention at 6 moAll subjects received a 24-mo behavioral weight loss program. Paper diary: Use paper diary for SM diet and exercise. PDA: Use PDA with dietary and exercise software. PDA includes date and time stamp to measure adherence to SM. PDA+FB: Use PDA for SM, automated message delivered daily and tailored to diary entries.δ % Weight loss at 6 moIntention-to-treat analysis: 6-mo weight change: Paper diary: 5.3%±5.9%PDA: 5.5%±7.0%PDA+FB: 7.3%±6.6% (P<0.12) Proportion of each group that achieved 5% weight loss (compared with PDA+FB 63%) Paper record: 46% (P<0.05)PDA 49% (P<0.05) Median % adherence to SM: Paper record 55%PDA 80%PDA+FB 90% (P<0.01)Ward et al, 200931Qualitative study to understand how obese black patients perceive the physician's role in the treatment of obesity and to identify specific provider behaviors that may motivate or hinder attempts at weight lossN=43 Women: 63% Age: 30–64 y (median 50 y) BMI: 30.2–57.7 kg/m2N/AQualitative study involving 8 focus groupsPhysicians must be cognizant of the potential unintended consequences of the techniques they use to educate and counsel black men and women on obesity, particularly those that may be perceived as negative and that act to further alienate obese patients from seeking the care they need.Dutton el al, 200432Cross-sectional, nonrandom sampling study to determine how patients prefer physicians to communicate about the topic of obesityN=143 Women: 89.5% White: 64.5% Age: 46.8±12.5 y BMI: 36.9±7.4 kg/m2Descriptor terms used to describe weightCross-sectional, nonrandom sampling study; patients who were seeking treatment for weight loss rated the desirability of 12 terms to describe excess weight, and physicians rated the likelihood with which they would use those terms during clinical encounters. Participants rated terms on a 5-point scale.Physicians generally reported that they used terminology that patients had rated more favorably, and they tended to avoid terms that patients may find undesirable.Whitlock et al, 200233Evidence-based approach. Promote broader appreciation of the importance of behavioral counseling interventions in clinical care and the context for their delivery.N/AN/AN/ABehavioral counseling interventions in clinical settings are an important means of addressing prevalent health-related behaviors, such as lack of physical activity, poor diet, substance (tobacco, alcohol, and illicit drug) use and dependence, and risky sexual behavior, that underlie a substantial proportion of preventable morbidity and mortality in the United States.Unrod et al, 200734Evaluation of the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by PCPsN=518 Intervention: n=270 58% Women61% WhiteAge 43.5±14.7 y Control: n=248 64% Women63% WhiteAge 42.8±14.2 yPhysician implementation of the 5 A's, quit rate, length of quit attempts, number of quit attempts, and stage-of-change progressionPhysicians and their patients were randomized to either intervention or control conditions. 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• W2034896661 title "New and Emerging Weight Management Strategies for Busy Ambulatory Settings" @default.
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