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), but 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:
Longer for more time: Weight and Lifestyle Inventory (WALI)
Quality of life or other measures related to the 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.
BHPs should use their typical scheduling and documentation templates for BHP weight-prioritized visits. WPV visit types are primarily used by PCPs
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 Behavioral Health Toolkit.
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.
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.
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.