A significant portion of the time spent in the evaluation and treatment of the obese patient can be expedited by use of protocols and procedures. A self-administered medical history questionnaire can be either mailed to the patient prior to the initial visit or completed in the waiting room. In addition to standard questions, sections of the form should inquire about past obesity treatment programs, a body weight history, current diet and physical activity levels, social support, and goals
and expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.
Identifying the body mass index (BMI) as a fifth vital sign may also increase physician wareness and prompt counseling. This method was successfully used in a recent study where a smoking status stamp was placed on the patient chart, alongside blood pressure, pulse, temperature, and respiratory rate . Use of prompts, alerts, or other reminders has been shown to significantly increase physician performance of other health maintenance activities as well. Once the patient is identified as overweight or obese, printed food and activity diaries and patient information sheets on a variety of topics such as the food guide pyramid, deciphering food labels, healthy snacking, dietary fiber, aerobic exercise and resistance training, and dealing with stress can be used to support behavior change and facilitate patient education. Ready-to-copy materials can be obtained from a variety of sources free of charge such as those found in the Practical Guide, or for a minimal fee from other public sites and commercial companies.
Based on the health promotion literature, use of written materials and counseling protocols should lead to more effective and efficient obesity care. In a study of community-based family medicine physicians, Kreuter et al. showed that patients were more likely to reduce smoking, increase physical activity, and limit dairy fat consumption when physician advice is supported by health education materials. In another randomized intervention study by Swinburn et al. a written goal-oriented exercise prescription, in addition to verbal advice, was more effective than verbal advice alone in increasing the physical activity level of sedentary individuals over a 6-week period. Several exercise assessment and counseling protocols have been developed that can be easily incorporated into obesity care.
These include Project PACE (Provider-based Assessment and Counseling for Exercise) , ACT (the Activity Counseling Trial), and STEP (the Step Test Exercise Prescription). Finally, protocols and procedures for various treatment pathways can be established for obtaining periodic laboratory monitoring and referral to allied health professionals, such as registered dietitians, exercise specialists, and clinical psychologists.
and expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.
Identifying the body mass index (BMI) as a fifth vital sign may also increase physician wareness and prompt counseling. This method was successfully used in a recent study where a smoking status stamp was placed on the patient chart, alongside blood pressure, pulse, temperature, and respiratory rate . Use of prompts, alerts, or other reminders has been shown to significantly increase physician performance of other health maintenance activities as well. Once the patient is identified as overweight or obese, printed food and activity diaries and patient information sheets on a variety of topics such as the food guide pyramid, deciphering food labels, healthy snacking, dietary fiber, aerobic exercise and resistance training, and dealing with stress can be used to support behavior change and facilitate patient education. Ready-to-copy materials can be obtained from a variety of sources free of charge such as those found in the Practical Guide, or for a minimal fee from other public sites and commercial companies.
Based on the health promotion literature, use of written materials and counseling protocols should lead to more effective and efficient obesity care. In a study of community-based family medicine physicians, Kreuter et al. showed that patients were more likely to reduce smoking, increase physical activity, and limit dairy fat consumption when physician advice is supported by health education materials. In another randomized intervention study by Swinburn et al. a written goal-oriented exercise prescription, in addition to verbal advice, was more effective than verbal advice alone in increasing the physical activity level of sedentary individuals over a 6-week period. Several exercise assessment and counseling protocols have been developed that can be easily incorporated into obesity care.
These include Project PACE (Provider-based Assessment and Counseling for Exercise) , ACT (the Activity Counseling Trial), and STEP (the Step Test Exercise Prescription). Finally, protocols and procedures for various treatment pathways can be established for obtaining periodic laboratory monitoring and referral to allied health professionals, such as registered dietitians, exercise specialists, and clinical psychologists.
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