Managing Obesity in a Primary Care Setting

The Situation

Obesity is a serious health condition that leads to or exacerbates other health conditions, including leading causes of death in the United States such as diabetes, heart disease, stroke and some cancers. Obesity results from behavior and, in some cases, genetics, but is also influenced by factors such as environment, food access and education. Overall, it is linked with poorer mental health outcomes and reduced quality of life. In 2017–2018, 42.4% of adults in the United States were obese and 9.2% of adults were severely obese. From 1999–2018, the percentage of obese and severely obese adults in the United States increased year over year.

The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen children, adolescents and adults for obesity using body mass index (BMI) measurement as the screening test. Other entities—the American Heart Association (AHA), the National Institute for Health and Clinical Excellence (NICE), the Canadian Task Force on Preventive Healthcare, the National Health and Medical Research Council (NHMRC) and the World Health Organization (WHO)—recommend at least one additional measure: waist to hip ratio, waist to height ratio or waist circumference, because BMI does not consider relative muscle and fat mass.

There are various treatment methods for obesity, depending on severity and patient need, but they generally fall into three categories: lifestyle and behavioral intervention, pharmacotherapy and weight-loss procedures. The end goal of treatment is not necessarily weight loss but a measurable improvement of the patient’s health and quality of life.

The Patient Perspective

NCQA spoke with people living with obesity to learn more about their experience with managing the disease.

To see the full video, check out the “Module 2: Patient Stories” section in the Improving Patient Outcomes for Obesity course.

What is NCQA doing? // What is NCQA’s Role?

NCQA provides education for primary care providers in addition to tracking and reporting data on two HEDIS measures related to weight.

Training: Improving Patient Outcomes for Obesity through Diagnosis and Management

This free continuing medical education course will provide health care professionals with the education to diagnose and manage obesity in adults through patient-centered care and to effectively meet the needs of patients through a variety of treatment options. The program will also educate participants on the capability of telehealth as a modality for engaging patients to improve outcomes and reduce disease burden.

HEDIS Measure: Adult BMI Assessment

This measure assesses children and adolescents 3-17 years of age who had an outpatient visit with a primary care practitioner or OB/GYN during the measurement year and had evidence of body mass index (BMI) percentile documentation, counseling for nutrition, and counseling for physical activity. Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed, rather than an absolute BMI value.

HEDIS Measure: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

This measure assesses chronic obstructive pulmonary disease (COPD) exacerbations for adults 40 years of age and older who had appropriate medication therapy to manage an exacerbation. A COPD exacerbation is defined as an inpatient or ED visit with a primary discharge diagnosis of COPD.