Weight Loss Programs Covered By Blue Cross Blue Shield – Health care provider counseling for weight loss among adults with arthritis and overweight or obesity—United States, 2002–2014.
Weight loss in adults with arthritis who are overweight or obese can improve pain, function, mobility, and health-related quality of life and reduce disability.
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From 2002 to 2014, the prevalence of weight loss advice from health professionals among adults with arthritis who were overweight or obese increased by 10.4 percentage points, from 35.1% to 45.5%.
Health Care Provider Counseling For Weight Loss Among Adults With Arthritis And Overweight Or Obesity — United States, 2002–2014
Providing weight loss counseling to overweight or obese adults with arthritis, along with other health behavior counseling, including physical activity and self-management education, can increase weight loss attempts and eventual success.
In the United States, 54.4 million adults report having doctor-diagnosed arthritis (1). Among adults with arthritis, 32.7% and 38.1% are also overweight and obese (1), with obesity being more common in people with arthritis than in people without arthritis (2). Additionally, severe joint pain in adults with arthritis was reported by 23.5% of overweight adults and 31.7% of obese adults in 2014 (3). The American College of Rheumatology recommends weight loss for adults with osteoarthritis of the hip or knee who are overweight or obese,* which can improve function and mobility while reducing pain and disability (4, 5). The Healthy People 2020 goal for health care providers (hereafter: providers) of weight loss counseling for people with arthritis and overweight or obesity is 45.3%.
Overweight or obese adults who receive weight loss advice from a provider are about four times more likely to try to lose weight than those who do not (6). Data from the National Health Interview Survey (NHIS) were analyzed to assess changes in the prevalence of weight loss counseling reported by adults with arthritis and overweight or obesity.
Overall, age-standardized estimates of weight loss counseling providers increased by 10.4 percentage points from 2002 (35.1%; 95% confidence interval [CI] = 33.0–37.3) to 2014 ( 45.5%; 95% CI = 42.9) – 48. <0.001). Providing comprehensive behavioral counseling (including nutrition, physical activity, and self-management education) and encouraging participation in an evidence-based weight loss program may lead to increased health benefits for this population.
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The NHIS is a continuous, in-person, cross-sectional survey of a civilian, non-institutionalized population. analyzed data on adults ≥18 years of age with arthritis and overweight or obesity from the 2002, 2003, 2006, 2009, and 2014 adult sample components (24,275–36,697; response rate = 58.9%–74.3%). Arthritis was defined as a positive response to the question “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?” Body mass index (BMI), defined as weight (kg) divided by height (m
), was calculated based on own height and weight and categorized as: normal/underweight (<25); overweight (25 to <30); and obese (≥30).
Obesity was further stratified into three BMI subgroups: class 1 (30 to <35); class 2 (35 to <40); and class 3 (≥40).** Provider counseling for weight loss, which was part of the sponsored survey content in 2002, 2003, 2006, 2009, and 2014, was defined as an affirmative response to the question: "Does a physician or Has another health care provider ever suggested that you lose weight to relieve arthritis or joint symptoms?
All analyzes included a comprehensive research design; Sampling weights were used to generate estimates representative of the US civilian, noninstitutionalized population. Weighted number and age-standardized prevalence (using assumed US population of 2000 aged 18-44, 45-64, and ≥ 65 years)
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Were calculated for overweight or obese adults overall and for selected sociodemographic and health characteristics for 2002 and 2014. Results were declared significant if t-tests yielded p-values <0.05 for differences in age-standardized prevalence between 2002 and 2014 and between characteristic categories in 2014.
Among US adults, 28.3 million people in 2002 and 38.9 million in 2014 had arthritis and were overweight or obese. From 2002 to 2014, the standardized prevalence of provider counseling for weight loss among adults with arthritis who were overweight or obese increased by 10.4 percentage points from 35.1% (95% CI=33.0-37, 3) at 45.5% (95.9% CI=42). –48.1) (p<0.001) (table), meeting the Healthy People 2020 target of 45.3%. Prevalence increased by 5.7 percentage points in adults with arthritis and overweight (from 18.1% to 23.8%; p = 0.006) and by 12.4 percentage points in those with obesity (50.4% to 62 .8%; p < 0.001). In the obesity subgroup, prevalence increased by 11.8 percentage points among those with obesity class 1 (40.8% to 52.6%; p<0.001) and by 15.5 percentage points among those with obesity class 3 (69, 0% to 84.5%; p<0.001); the increase in people with class 2 obesity was not significant (picture). In 2014, among adults with arthritis who were overweight or obese, the prevalence of counseling by a weight loss counselor was significantly higher among women (vs. men), obese (vs. overweight), those who had ever were on consultation with health workers, until physical activities. for arthritis treatment (vs. those who did not), those who had ever attended a course or self-management course (vs. those who did not) and those who had primary care (vs. those who did not) (Table).
From 2002 to 2014, the percentage of adults with arthritis who were overweight or obese who reported receiving weight loss advice from a provider increased by 10.4 percentage points. These improvements are encouraging; however, approximately 75% of overweight adults and 50% of class 1 obese adults do not receive medical advice for weight loss.
A recent report reported that 61.0% of adults with arthritis received advice from a physical activity provider in 2014 (7), more than the 45.5% reported for weight loss. Providers may recommend physical activity more often than weight loss because the former may be easier to discuss with patients or they may be more aware of the arthritis-specific benefits of physical activity. The findings of this report suggest that those who do not receive weight loss counseling may not receive physical activity advice either. However, to address obesity, the US Preventive Services Task Force recommends that providers either provide or recommend to patients intensive, multicomponent behavioral interventions that include management strategies (eg, goal setting), changes in diet and physical activity, removal of barriers to change , self-tracking. monitoring and strategies for maintaining healthy behavior.
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The American College of Rheumatology also recommends that providers offer counseling about weight loss and physical activity to adults with osteoarthritis of the hip or knee. In randomized controlled trials, a combined exercise and diet intervention resulted in the greatest improvements in weight, pain, joint strength, inflammatory factors, and mobility compared to the intervention alone (4, 8). In the current study, the percentage of overweight or obese adults who received weight loss counseling was higher among those who received self-management education than among those who did not. Because the time sequence of provider weight loss counseling and completion of a self-management education course (which included weight loss messages) could not be determined, this study could not determine whether provider counseling leads people with arthritis and overweight or obesity to self-care. – management. educational courses or vice versa. However, it is possible that people with arthritis who receive recommendations from their doctor for healthy behaviors, such as weight loss, are more willing to engage in other self-management behaviors, such as taking a self-management course or engaging in physical activity. . .
One of the benefits of participating in self-management education programs is a significant increase in self-esteem (9), an important trait that can help adults with arthritis follow advice to lose weight and be physically active. A combination of weight loss counseling, physical activity, and self-management education can improve arthritis and other health outcomes.
Strategies to increase provider weight loss counseling include health system interventions (eg, electronic medical record to support clinical decision making) and physician training. Electronic medical records that support clinical decisions are effective in increasing dietary and physical activity counseling and reducing BMI in children with obesity (10), and similar strategies can lead to weight loss in the adult population. Standardized clinical decision support in the electronic health record could assist providers in counseling and recommending evidence-based weight loss and physical activity programs implemented by the community, intensive multicomponent interventions, or bariatric specialists, as well as facilitate patient education and assist providers in patient follow-up -above . ‘ weight loss goals and progress. Increased provider training in self-management support strategies can help providers gain the skills and confidence to provide successful weight loss counseling. Such training may include formal classroom instruction or the use of publicly available online resources to counsel your patients.***
Many effective strategies, including motivational interviewing, the 5A approach (assess, advise, agree, assist, and agree), and emphasizing that small changes can have a big impact, are applicable to weight loss counseling (6). For example, in addition to improving pain and mobility (4), a relatively small but clinically significant weight loss of 5.1% over 20 weeks can significantly reduce functional disability in patients with knee osteoarthritis and obesity (5).
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The findings in this report are subject to at least four limitations. First, NHIS data are self-reported and some characteristics may be subject to bias or social desirability bias. In particular, the latter may lead to an underestimation of BMI (2). Second, low response rates may also introduce response bias; however, the sampling weights used in the analysis include adjustment for nonresponse. Third, using BMI to classify the risk of overweight and obesity misclassifies some
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