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1-Minute Consult

Can effective obesity counseling fit into the 20-minute appointment?

John A. Zambrano, MD, MHS and Bartolome Burguera, MD, PhD
Cleveland Clinic Journal of Medicine November 2017, 84 (11) 835-837; DOI: https://doi.org/10.3949/ccjm.84a.16034
John A. Zambrano
Department of Internal Medicine, Harvard Vanguard Medical Associates, Atrius Health, Boston, MA
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  • For correspondence: John_Zambrano@atriushealth.org
Bartolome Burguera
Bariatric and Metabolic Institute, Cleveland Clinic
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    TABLE 1

    The 5 A’s approach to reimbursable obesity counseling

    Focus on:Target this information:
    Assess (obtain this information in advance)Weight historyCurrent body mass index (BMI) (kg/m2)
    Maximum weight, minimum weight, ideal weight
    Previous weight loss efforts
    Eating habitsNumber of meals per day
    Typical breakfast, lunch, dinner
    Quantify daily intake of sugary beverages
    Appetite
    Physical activityQuantify amount and type
    AdviseGoals3% to 5% weight loss over 6 months (3 kg for Medicare patients)
    6-month commitment to losing weight
    150 minutes of moderate-intensity aerobic activity per week
    Treatment planCreate-your-plate method
    Mediterranean diet
    Consider role of pharmacotherapy for weight loss
    AgreeGoalsUse motivational interviewing, shared decision-making, and information from Assess and Advise
    AssistIdentify barriersScreen for depression
    Ask about access to healthy foods
    Identify social support for weight loss
    Review current medications to identify those that promote weight gain
    ArrangeFollow-up and referralsConsider consultation by a nutritionist or dietician
    Consider group support sessions
    Bariatric surgery consultation for patients with BMI ≥ 40 kg/m2, or for patients with BMI ≥ 35 kg/m2 and obesity-related comorbidities who have not responded to behavioral therapy
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Cleveland Clinic Journal of Medicine: 84 (11)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 11
1 Nov 2017
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Can effective obesity counseling fit into the 20-minute appointment?
John A. Zambrano, Bartolome Burguera
Cleveland Clinic Journal of Medicine Nov 2017, 84 (11) 835-837; DOI: 10.3949/ccjm.84a.16034

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Can effective obesity counseling fit into the 20-minute appointment?
John A. Zambrano, Bartolome Burguera
Cleveland Clinic Journal of Medicine Nov 2017, 84 (11) 835-837; DOI: 10.3949/ccjm.84a.16034
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  • Article
    • START WITH SCREENING
    • OBTAIN AN OBESITY HISTORY
    • SUGGEST SPECIFIC GOALS
    • CO-DEVELOP A TREATMENT PLAN AND ADDRESS POTENTIAL BARRIERS
    • ARRANGE FOLLOW-UP AND REFERRALS
    • OBESITY COUNSELING IS ACHIEVABLE AND REIMBURSABLE
    • REFERENCES
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