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Currently Skimming:

14 PatientProvider Communication around Obesity Treatment and Solutions
Pages 121-142

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From page 121...
... (Smith) • Multiple challenges to obesity care exist in health care set tings, giving rise to differential health care experiences for patients with obesity that can affect the treatment received.
From page 122...
... Preventive Services Task Force (USPSTF) recommendation for childhood obesity, patient– provider communication challenges and ethical issues associated with the recommendation's implementation, and systems-wide methods for addressing inequities in the implementation of childhood obesity recommendations.
From page 123...
... Smith then compared the USPSTF's recommendations for childhood obesity screening and adolescent depression screening. In 2009, he said, it issued a grade B recommendation for screening 12- to 18-year-olds for depression only when systems are in place and accessible to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
From page 124...
... More evidence is also needed, he argued, regarding what constitutes clinically important health benefits, as well as the amount of weight loss associated with those benefits. Studies addressing behavioral interventions in diverse populations and in children aged 5 years and younger are also needed, he suggested, to determine whether preventive interventions and screening modalities are effective for all groups or more tailored recommendations are warranted.
From page 125...
... Some communities may be unable to offer evidence-based interventions, he acknowledged, but may be able to spotlight the issue and provide alternative, less resource-intensive options, recognizing possible gaps in the evidence for their effectiveness. Looking further upstream, Smith promoted the value of targeting social determinants to address childhood obesity, arguing that children deserve to reach adulthood with the ability to pursue their goals unencumbered by the physical and mental impairments resulting from obesity.
From page 126...
... Gudzune began by observing that multiple challenges to obesity care exist in health care settings. She cited the examples of incomplete insurance coverage for evidence-based treatments (e.g., behavioral weight-loss counseling, antiobesity medications, bariatric procedures)
From page 127...
... As another challenge she pointed to clinicians' lack of time to perform obesity care services -- assuming they are even trained to provide them -- as well as a broader problem of clinicians themselves serving as a source of stigma for patients with obesity (Gudzune et al., 2012; Kushner, 1995; Mastrocola et al., 2020; Puhl and Brownell, 2001)
From page 128...
... . This differential treatment extends to clinicians' lower likelihood of counseling patients about weight loss, she continued, for such reasons as perceiving limited efficacy or futility of obesity treatment, feeling unprepared with respect to training, having limited time and reimbursement for services, and ranking weight-loss counseling low on the list of multiple issues to address during a care visit (Fogelman et al., 2002; Foster et al., 2003; Gudzune et al., 2012; Kristeller and Hoerr, 1997; Kushner, 1995)
From page 129...
... . Gudzune added that interventions to address clinician barriers might include providing education -- from medical school through board certification and in continuing medical education -- on the multifaceted contributors to weight gain and loss; conducting training on evidence-based counseling techniques; leveraging electronic health records to support counseling; and improving access by advocating for coverage of evidence-based obesity treatments with insurers, employers, and government agencies.
From page 130...
... UNDERUTILIZATION OF BARIATRIC SURGERY: HEALTH INSURANCE DESIGN, WEIGHT STIGMA, AND PATIENT–PROVIDER COMMUNICATION David B Sarwer, associate dean for research and director of the Center for Obesity Research and Education at Temple University College of Public Health, discussed access to care and insurance coverage for bariatric surgery, along with the potential benefits of a shared decision-making approach for engaging patients in obesity treatment.
From page 131...
... . Sarwer pronounced this a profound health disparities issue, maintaining that the underutilization of bariatric surgery reflects issues of health insurance coverage and benefits design, weight bias and stigma, and patient– provider communication (Sarwer et al., 2021)
From page 132...
... Individuals with preferred provider organization (PPO) and feefor-service insurance plans within the private insurance category had greater odds of undergoing the surgery relative to those with private health maintenance organization (HMO)
From page 133...
... Sarwer ended his presentation by discussing shared decision making as it relates to navigating a patient's options for obesity treatment. Shared decision making, he explained, is a process whereby patient and provider actively share information and work collectively to come to a treatment decision that meets the patient's needs (McCaffery et al., 2010)
From page 134...
... Finally, he urged providers to identify novel strategies for ensuring that patients with clinically severe obesity and related morbidities are informed of the most appropriate treatments available to them. AUDIENCE DISCUSSION Following Sarwer's presentation, Ard asked him to share his perspective on how people perceive surgical treatment in initial discussions about obesity treatment options.
From page 135...
... Smith, Gudzune, and Sarwer discussed a range of topics that included initiating conversations with patients about obesity treatment, discussing the impact of social determinants on obesity, communicating the long-term nature of treatment, promoting shared decision making, integrating synergistic clinical care models, novel settings for weight management strategies, ideal coverage scenarios for obesity treatment, and key priorities for improving patient–provider communication about obesity. Initiating Conversations with Patients about Obesity Treatment Ard opened the discussion by asking the panelists for practical tips on broaching the topic of obesity treatment with patients.
From page 136...
... This context helps set the stage for a better patient–provider partnership, she maintained, by aligning expectations and helping the provider provide appropriate treatment recommendations. Smith echoed Gudzune's advice and shared his view that asking patients how they feel about their weight status is a way both to introduce the topic and to discover a patient's level of readiness and willingness to pursue weight loss.
From page 137...
... He suggested comparing obesity to other types of chronic relapsing conditions, such as chronic pain, to help convey the message that persistent effort is required to achieve and maintain weight loss. Promoting Shared Decision Making Smith suggested, first, that providers consider the various shared decision-making approaches and philosophies that exist and then choose a decision-making tool that corresponds to the approach they want to pursue.
From page 138...
... Another member of the treatment team may be able to step in, he remarked, adding that nonphysician, non–doctoral-level providers can also be trained to provide effective weight management counseling. Integrated Synergistic Clinical Care Models The three speakers agreed that reliance on comprehensive obesity treatment programs is insufficient and that multilayered approaches are imperative to address the systemic factors that contribute to the development of obesity and propagate weight stigma.
From page 139...
... Envisioning an Ideal Coverage Scenario for Obesity Treatment Asked to envision the components of a comprehensive health plan that would include coverage of obesity treatment for children and adults, Gudzune espoused coverage for three primary categories of intervention: lifestyle/behavioral counseling, pharmacotherapy, and surgical procedures. She stressed the importance of having multiple options for patients within each type of intervention, describing an example scenario whereby a plan would cover behavioral counseling in primary care settings, but this treatment would become inaccessible if the provider were not trained to offer that service.
From page 140...
... Improving Patient–Provider Communication about Obesity The panelists' final comments highlighted key priorities for improving patient–provider communication about obesity. Smith reiterated his emphasis on discussing the influence of social determinants of health on obesity status.
From page 141...
... More research is needed, he asserted, to better inform the field about how to care for those patients. Lastly, he envisioned an ideal scenario of comprehensive obesity care centers where multidisciplinary professionals would converge to provide holistic, patient-centered care.


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