Tipping the scales: Provider perspectives on a multi-disciplinary approach to obesity

Abstract

Obesity is a costly and complex health issue that precipitates and/or complicates many medical conditions. Clinical recommendations include a comprehensive approach to weight loss with a combination of diet, physical activity, behavioral interventions, pharmacotherapy or surgery to achieve weight loss. Care in the primary care setting is integral in obesity management. Outside of their clinical role, primary care physicians serve as role models, educators, and promoters of healthy lifestyle practices and leaders in obesity treatment. Physician recommendations have consistently been shown to exert a powerful influence on patient behavior, but there is a substantial gap between patients who would benefit from obesity care and those receiving it. Providers, especially primary care, cite many obstacles to addressing obesity including lack of time, expertise, and resources. This review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs. A literature search was conducted in Med Line and PubMed for published articles on multidisciplinary weight management programs that included lifestyle modification (diet and exercise), behavioral modification and a physician (MD/DO) with one or more of the following multidisciplinary team members: nutritionist/registered dietician (RD), behavioral health provider (BH), case manager (CM), pharmacist (Pharm), nursing (RN), and research staff. Relevant articles from bibliographies of systematic reviews/meta-analyses were included as well. Ten studies qualified, and we organized the articles to discuss the following three themes: diet and exercise, behavioral therapies and barriers, and facilitators for clinical weight management programs. The studies in this mini-review of multidisciplinary weight programs that included physicians reiterate the guidelines for successful treatment of obesity, with more research needed to fully understand how primary care providers can assist higher risk patient populations, particularly those of lower socioeconomic status who are disproportionally impacted by obesity.

Impact statement

Obesity is a major multi-faceted, chronic disease that increases the risk of morbidity and mortality of children and adults particularly impacting high-risk populations and those of lower socioeconomic status. Given provider time constraints, models of care to effectively and efficiently address obesity in primary care are key. Although physician recommendations can exert a powerful influence on behavior, providers often feel powerless to adequately address obesity due to the complexity of physical and behavioral health problems. This mini-review focuses on describing the feasibility and evidence for tackling obesity through provider-led multidisciplinary weight management programs.