Fast Five Quiz: Confronting Obesity

Romesh Khardori, MD, PhD; Elif A. Oral, MD


December 05, 2023

Current guidelines on obesity counseling from the Society of Behavioral Medicine describe the 5As counseling framework (Assess, Advise, Agree, Assist, and Arrange). The Assess step involves screening for obesity, comorbidities, and patient willingness to make health-related behavioral changes. The terms "obese" and "obesity" have been associated with stigma, so patients might prefer that providers refer to their actual weight or BMI. For example, instead of referring to obesity, providers should instead say, "Your current BMI puts you at risk for cardiovascular disease."

During the Advise step, physicians should inform patients that no single diet is best for weight loss, although health benefits have been shown with low-fat, low-carbohydrate, vegetarian, plant-based, and Mediterranean diets. Physicians should not impose their personally preferred diet on a patient because it might be in opposition to the patient's preferences, which might result in treatment failure.

In the Agree step, appropriate behavioral goals should be set with patients that are specific, measurable, attainable, relevant, and time-based. For example, "I will walk for 30 minutes three times per week" is recommended instead of the general "I will exercise more." Patients often have unrealistic weight loss goals that are too broad, which can lead to disappointment.

During the Arrange step, increasing accountability with regular (eg, monthly) follow-up is critical to maximizing success. Patients with slow or negligible weight loss in the first month should be referred for more intensive counseling with a behavioral specialist or registered dietitian.

Learn more about obesity management.


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