The obesity problem in this country, its effects on health and by extension, healthcare costs, are (pun intended) enormous. The impact of so many overweight citizens affects every state and every community. There is no one-size-fits-all solution to the problem, and it may take more than a medical approach to solve it. A recent study suggests a partnership that may be helpful.

According to the Centers for Disease Control and Prevention, one-third of the adults in the United States are obese, and the problem continues to grow. There were 2.4 million more obese adults in 2009 than in 2007. Obesity is expensive. Its cost to the healthcare system in 2008 was estimated to be nearly $147 billion, and the medical costs for obese individuals were $1,429 higher than those of normal weight.

Many believed BMI should be considered a fifth vital sign.

Of the one billion visits to physicians in 2009, 56% were to primary care physicians (PCPs) which puts them in a unique position to treat obesity. But despite guidelines encouraging PCPs to counsel patients to lose weight, just one-third of obese patients say they received a diagnosis of obesity, much less weight-related counseling.

Over 500 primary care physicians participated in a survey designed to look at their perspectives on the causes of obesity and ways to improve care. They answered questions about the causes of obesity and their ideas about physicians' competence in treating obesity, as well as the health professional best qualified to help patients lose and maintain weight, and ways to improve care for obese patients.

Most PCPS surveyed agreed that behavioral factors were the main cause of obesity, including lack of physical activity, overeating, eating out, consumption of sugary beverages, and lack of willpower. Other findings from the survey included the need for additional training programs for PCPS, nutrition counseling options for patients, and scales the provide body mass index (BMI). Many believed BMI should be considered a fifth vital sign.

When asked about the healthcare provider most qualified to help patients lose or maintain their weight, 45 percent of PCPS believed nutritionists and dietitians were better suited to the job, while 39 percent identified themselves. Nearly all of the PCPs said they felt competent to provide weight-loss counseling (diet and exercise), but less than half said they had ever succeeded in helping patients lose weight.

It should be noted that a nutritionist and a dietitian do not necessarily have the same training and qualifications.

Shifting some obesity care responsibilities to nutritionists and dietitians should be considered, according to the researchers, especially in light of provisions for care coordination under the Patient Protection and Affordable Care Act. The Patient Centered Medical Home recommends including dietitians as a part of the healthcare team to support primary care physicians. Perhaps, state the authors, a new model for the treatment of obesity should link PCPs, nutritionists and dietitians, and other health professionals together in behavioral weight-loss intervention programs.

It should be noted that a nutritionist and a dietitian do not necessarily have the same training and qualifications. A registered dietitian (RD) is highly trained in all aspects of food and nutrition and has the skill and knowledge to translate the sometimes complicated and misunderstood science of nutrition into practical recommendations that fit within a patient’s lifestyle and food preferences. A person who claims to be a "nutritionist" without the RD credential is not necessarily a qualified nutrition professional. State licensure laws dictate who can call themselves a "nutritionist" and laws vary from state to state.

The study was published in BMJ Open.