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.
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.
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:
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:
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.
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:
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.
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.
For additional tools and links to weight management handouts, download the PATHWEIGH behavioral health toolkit.
Behavioral health toolkit video
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.
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.
Books for Clinicians:
Self-help resources for patients:
Websites:
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:
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.