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

Article Figures & Data

TABLE 1

The 5 A’s approach to reimbursable obesity counseling

	Focus on:	Target this information:
Assess (obtain this information in advance)	Weight history	Current body mass index (BMI) (kg/m²) Maximum weight, minimum weight, ideal weight Previous weight loss efforts
	Eating habits	Number of meals per day Typical breakfast, lunch, dinner Quantify daily intake of sugary beverages Appetite
	Physical activity	Quantify amount and type

Advise	Goals	3% 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
Advise	Treatment plan	Create-your-plate method Mediterranean diet Consider role of pharmacotherapy for weight loss

Agree	Goals	Use motivational interviewing, shared decision-making, and information from Assess and Advise

Assist	Identify barriers	Screen for depression Ask about access to healthy foods Identify social support for weight loss Review current medications to identify those that promote weight gain

Arrange	Follow-up and referrals	Consider 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