FIU researchers: Most patients with obesity don't get the weight counseling they need

There's no shortage of weight-loss advice on social media, TikTok, television, and AI chatbots. But the most credible source — a patient's own primary care doctor — is often the one they're not hearing from.

Fewer than one-quarter of obese patients receive weight-reduction counseling during their primary care office visits, according to a new study by physician-investigators at Florida International University Herbert Wertheim College of Medicine and Baptist Health. The findings point to a gap in care that, if addressed, could help curb the nation's obesity crisis.

The counseling gap

The observational study, published in the Journal of Internal Medicine, analyzed more than 289 million patient visits nationwide. It revealed that fewer than 25% of obese patients were given exercise advice, and only 33.9% received dietary recommendations.

"By 2048, it's estimated that half of Americans will be obese, even with the impact of newer medications, such as GLP-1s," said first author Dr. Muni Rubens, a resident physician training in the FIU/Baptist Health Internal Medicine Residency program. "With serious health conditions like diabetes, cancer and heart disease linked to obesity, we have a significant problem."

A body mass index (BMI) of 30.0 or higher lands a patient in the obese category. A BMI of 40.0 or higher is considered severe obesity. More than 40 percent of adults today are obese, according to the Centers for Disease Control and Prevention.

Given the current climate around weight management and the intense national attention on GLP-1 medications, the results weren't entirely surprising, said senior author Dr. Elise McCormack-Granja, internal medicine physician with Baptist Health Medical Group, assistant professor and an associate program director of the FIU/Baptist Health Internal Medicine Residency. Still, they were a wake-up call about the role primary care physicians play in the fight against obesity.

"Many people are getting their advice from social media," McCormack-Granja said. "That is a risk. We need to build relationships with our patients and spend the time to talk with them so that we can develop specific, measurable guidance for the individual, rather than generic advice like: Don't eat fast food!"

Training physicians to address obesity

In response, the FIU/Baptist Health Internal Medicine Residency program is already changing how the next generation of physicians is educated. A lifestyle medicine rotation is built into its curriculum, along with training modules on healthy eating, weight loss and cardiovascular health.

"We must convey to students the importance of carving out time in primary care visits just for counseling," Rubens said. "This is about preventing critical diseases."