Primary care physicians assigned front line in obesity Tx.(Clinical Rounds)

LAS VEGAS -- In theory, team management of obese patients makes a lot of sense.

But in the real world, it may not be possible, because the obesity epidemic is too big, trained specialists too few, and resources too scarce, Arthur Frank, M.D., said at the annual meeting of North American Association for the Study of Obesity.

Primary care physicians must diagnose and treat obese patients in their practices, according to Dr. Frank, medical director of the weight management program at George Washington University in Washington.

His remarks opened a workshop on office management of obesity--a subject revisited several times during the meeting, cosponsored by the American Diabetes Association. Here are some practical suggestions from experts in the field:

Guidelines and Other Tools

"The best way to describe the current management of obesity is clinical inertia," Robert E. Kushner, M.D., said. "If the patient doesn't lose weight, what does the doctor do? He talks louder."

Treatment guidelines are part of the problem, said Dr. Kushner, medical director of the Wellness Institute at Northwestern University, Chicago. There are too many of them--more than 2,000 at last count, including 135 at the National Guidelines Clearinghouse (www.guidelines.gov), he said--and even the best can be vague about treatment recommendations.