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Progress in Prevention: New Evidence and Policy Support Primary Care–Based Weight Loss Interventions
Cheryl R. ennison Himmelfarb RN, ANP, PhD, FAHA, FPCNA, FAAN

Journal of Cardiovascular Nursing
October 2012 
Volume 27  Number 5
Pages 379 - 381
  PDF Version Available!

Obesity has become ubiquitous in the primary care setting. More than one-third of adults in the United States are obese, and prevalence of obesity is even higher among those with chronic conditions such as cardiovascular disease and diabetes.1 Obesity adversely affects blood pressure, lipid profile, and diabetes, all major cardiovascular risk factors. As a consequence, obese individuals have increased risk of death, especially from cardiovascular disease.2 The US Preventive Services Task Force3 recommends screening of all adult patients for obesity and offering intensive, behavioral counseling to promote sustained weight loss for obese adults. However, recent data indicate that less than half of primary care physicians record body mass index (BMI) regularly or provide specific guidance on diet, physical activity, or weight control; about one-fifth systematically track weight or weight-related behaviors; and less than 10% refer patients for further evaluation or weight management.4 The barriers to treating obesity in the primary care setting are numerous and include inadequate guidance on how to provide effective behavioral weight loss counseling.3,5,6 Two recent trials of weight loss interventions delivered in primary care settings to obese patients with cardiovascular risk factors over 2 years provide evidence that begins to bridge this gap.7,8 Inadequate reimbursement for weight loss counseling is another long-standing barrier to obesity treatment in primary care settings. However, in late November 2011, the Centers for Medicare and Medicaid Services (CMS) announced that it will cover obesity screening and counseling as a preventive service under Medicare.9 New evidence supporting the effectiveness of weight loss counseling strategies in conjunction with CMS reimbursement for these services offers potential to dramatically increase the number of individuals who receive screening and treatment for obesity in primary care.In the first trial, Appel et al7 randomly assigned

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