Behavioral health resources

Effective, sustainable weight management involves learning and then intentionally implementing healthy lifestyle behaviors, as well as an awareness for how things may throw us off track and how we can get back on track.  Success can take time, planning, persistence, patience, and commitment to making healthy choices daily.

Having support around shifting habits and patterns of behavior is integral to achieve desired weight outcomes. This is where a Behavioral Health Provider (BHP) can be an effective part of the weight management team.

Overview for the role of the BHP in weight management

BHP types

Not only are BHPs in primary care trained to support patients who may be struggling with a wide range of behavioral health concerns (e.g., depression, anxiety, trauma, substance use), they can also help patients with health behavior change, including weight management. By targeting the behaviors associated with increased weight and collaboratively creating a plan with patients, BHPs can help patients transfer the what (what they need to do/eat/change) into the how. In some cases, patients need information on specifics (types of foods to eat/avoid) to be successful with weight loss. But many patients have a general understanding of what they need to be doing. Their challenge is putting this knowledge into practice and developing healthy habits.

Shifting into weight management for BHPs

For some clinics, using BHPs to help with weight management can be new. Here are some ideas to support your clinic in engaging BH support:

  • Discuss with your clinic leadership team about your interest in more weight management consults, and get their feedback on workflow considerations to support this.
  • Present at a clinic team meeting how BHP can be helpful in working with patients who want to focus on weight loss. Medical assistants can be helpful in pending BHP referrals or alerting providers when patients indicate they might benefit from meeting with BHP.
  • Create handouts to remind providers about considering BHP for their patients when they have a weight prioritized visit.
  • Scrub schedules and discuss with providers opportunities for warm handoffs.
  • Make it patient-driven: include visuals or action plans that are readily accessible in exam rooms, like this one.
  • Work with a physician champion to build up more consults with their panel of patients.
  • Share success stories or tips on behavioral weight loss strategies through emails, newsletters, team meetings etc. to keep focus on this type of support.

Thinking about using your BHP to support weight management

Here are some tips to consider during weight prioritized visits when you want to discuss using your BHP as a part of their care team:

  • Language matters - it can be helpful to normalize seeing a BHP because, unfortunately, there can still be a stigma. Here are examples of scripting for this:
    • “I have a colleague who specializes in behavioral strategies to support weight management that I would like to introduce to you today.  Would that be ok?”
    • "We take a team approach to weight management to fully support your health goals. One of my teammates focuses on strategies and behaviors to help you be most successful in achieving your goals. Would you like to meet her today?”
  • Comorbidity problems can complicate weight management success. BH can help with these problems. Considerations include:
    • stress (job stress, family stress, relationship stress, life stress),
    • insomnia,
    • emotional or stress eating,
    • binge eating,
    • sedentary lifestyle,
    • substance use,
    • depression,
    • trauma

Example of a workflow to support team-based care with a BHP for patients prioritizing weight:


Considerations for an Initial Weight Prioritized Behavioral Health Visit

Screening Tools

When having an initial weight prioritized visit, a BHP may choose to supplement screening tools they already use in primary care for common presenting concerns (i.e., GAD-7, PHQ-9, MDQ, PCL-5, AUDIT, DAST, etc.) with additional tools related to weight history and eating behaviors. This may include:

The Eating Disorder Examination Questionnaire (EDE-Q)

Questionnaire on Eating and Weight Patterns -5 (QEWP-5)

International Physical Activity Questionnaire - Short Form

Longer for more time: Weight and Lifestyle Inventory (WALI)

Quality of life or other measures related to assessment of obesity and a discussion of their psychometric properties can be found here.

Evaluating Contextual Factors

In order to be effective in guiding individualized treatment, it is vital to have an understanding of the patients’ contexts for how their weight came to be a concern. This involves gathering a thorough biopsychosocial history with a focus on the patient’s:

  • Relationship to food (24-hour food intake recall)
  • Weight history (When did this start? Has it been life-long or did it become harder as an adult or following critical periods - childbirth, surgeries, illnesses, etc.?)
  • Family and cultural factors (family history of weight concerns, family behaviors around food, holiday meals, etc.)
  • Current stressors
  • Social supports
  • Potential barriers
  • Past successes or attempts at weight loss
  • Current coping strategies (both healthy and potentially maladaptive)

Note that when the patient completes a weight prioritized visit, many of these questions are in the PATHWEIGH questionnaire. The BHP may choose to review the patient’s answers and the clinician’s notes or may conduct additional assessments.

Behavioral strategies that are effective for weight management

A number of skills have been found to be effective when working with patients focusing on weight management. Here are just a few, with some additional resources provided. Note that these strategies are also included in the PATHWEIGH smart set for a clinician visit.

  • Self-monitoring - tracking what are you eating, how much, when and why can be a helpful foundation to assess what tweaks to start with,. Monitoring itself helps us change what we do.
  • Stimulus control strategies - setting our future selves up for success means creating an environment to help support us. This might be changing what’s available to eat (getting rid of the junk makes it harder to access) or other cues in the environment to help us be healthy (e.g., putting out our workout clothes the night before may make it more likely that we will get into them the next morning).
  • Problem solving - planning and preparing for meals, fitting physical activity into a busy work week, and preparing for meals while at restaurants, on vacations, and during holidays all require problem-solving to stay on track.
  • Cluing in to hunger and satiety cues vs other reasons for eating - it’s not uncommon to use food as a coping strategy. Supporting non-food related coping skills can help individuals self-soothe that won't derail their lifestyle.
  • Relapse prevention - patients can learn how to recognize when their behavior goes off track and how to readjust to continue  maintaining behavior changes.

For additional tools and links to weight management handouts, download the PATHWEIGH behavioral health toolkit.

Behavioral health toolkit video

Behavioral health learning community

A learning community specific to the behavioral health aspect of weight-prioritized team-based care will be hosted monthly via a zoom call. This learning community is primarily for BHPs who provide weight management assistance; however, anyone from the practice team interested in this topic is welcome to join.

  • The purpose is to support anyone working on or interested in providing behavioral health interventions targeting weight management.
  • The community will provide an opportunity to learn from one another, discuss strategies, lessons learned, and tips to support clinical care. It will also provide ongoing education and support.
  • Email to be invited.

Behavioral health billing for weight management

To make engagement in behavioral weight management support for your clinic sustainable, ensure that billing practices support the work. Billing for BHPs in integrated primary care settings depends on a number of factors including state guidelines, credentials, and type of visit. Psychotherapy codes (90791; 90832; 90834; 90837, etc.) require a mental health diagnosis. Patients who have a comorbid mental health diagnosis that is impacting their ability to successfully manage their weight might qualify for this type of billing. Absent a mental health diagnosis, there may still be patient behaviors or psychosocial concerns that are impacting a medical condition. Psychological Factors Affecting a Medical Condition (PFAMC; F54) is one such diagnosis that may be pertinent in situations in which a patient’s behaviors are affecting weight.

Health and Behavior Codes are also available to bill for medical conditions as primary to the visit. Further information on billing for behavioral health can be found below:

Talk with your billing and coding specialist to investigate options for reimbursement available at your practice and to ensure that the appropriate authorizations are done when referring patients to your BHP.

Additional treatment resources for BHPs:

Books for Clinicians:

Self-help resources for patients:


Trainings and Webinars for BHPs:

Medical providers/clinics without a BHP

If your practice doesn’t have behavioral health but is interested in including a BHP as a part of your care team, there are many online resources and toolkits that have been developed to support practices in navigating this. Resources range from decisional support tools on the type of model that would work best for your practice to how to recruit a BHP in your community.

Tips for PCPs on supporting patients with weight loss

It is important to build comfort in approaching and discussing strategies to manage weight with patients. Practice and get familiar with key phrases that bring this topic up in a non-judgmental, compassionate, and solution-focused way. Below are some suggestions to help you start this conversation, as well as tools to support using motivational interviewing strategies to discuss weight management with patients.

Tips for PCPs on supporting patients with BH needs when you don’t have a BHP

Patients with comorbid behavioral health concerns present to primary care for management of their medications or support. This situation often requires the primary care providers to flex their generalist practice into more specialist psychiatric management of care, potentially bumping up against what they feel is within their scope of practice. Individual providers’ differing comfort with assessing and treating behavioral health conditions can be impacted by what resources in the community are available and how much a provider has to try to hold on their own vs referring out to others. For providers with limited behavioral health resources, here are some tips to support your patients:

  • Assess – Universal behavioral health screening (PHQ-9; GAD-7; SBIRT) provides some indication for how your population is doing and identifies those that might be struggling with common behavioral health conditions.
  • Provide empathic listening – The patient-doctor relationship is built on trust. Providing a space to share struggles and be heard in a non-judgmental and compassionate way is a powerful mechanism for change to occur.
  • Brief intervention – Start with small, measurable, committed actions that are in line with a patient’s goals or would help provide some symptom relief.
  • Build community connections – Network with community mental health providers, private practice clinicians, or other resources in your area that might be a referral option for your patients. The advancement of teletherapy options is an additional way to increase behavioral health access for rural practices. Building these relationships can support effective continuity of care linkages and ongoing co-management of behavioral health conditions.

However, despite all these strategies, your patients may need to be referred for additional mental health resources. Here are some avenues for referral to behavioral health. You can utilize your existing contacts for behavioral health support and encourage them to learn skills to help your patients with weight management behavior change as well.

  • - offers a directory of mental health providers that you can filter by location, insurance, type of therapy offered, etc.
  • Colorado Department of Human Services – linkages to Colorado community mental health centers, the CO Crisis Service, and additional substance use providers.