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_Includes 12 to 26 face-to-face meetings over a year, most in the first few months.

_Makes patients set realistic weight-loss goals. Losing just 5 percent of your initial weight _ 10 pounds for a 200-pound person _ can significantly improve health.

_Analyzes what blocks each patient from reaching those goals. Do they eat high-calorie comfort foods to deal with depression? Spend too much time at a desk job?

_Tailors ways to help people integrate physical activity into their daily routine.

_Requires self-monitoring, such as a food diary or a pedometer to track activity.

Last year, Medicare started paying primary care doctors for obesity screening and weight-loss counseling for seniors for a year, including weekly meetings for the first month.

But many insurance companies don’t pay for all the suggested interventions, and comprehensive programs aren’t available everywhere, says Dr. Scott Kahan of George Washington University and the STOP Obesity Alliance. He runs a clinic that provides a medical, psychological and nutritional evaluation before tailoring a plan. In other programs, primary care doctors may offer some counseling and send patients to nutritionists or other specialists for extra help.

Another problem: “Doctors tend to shoo away people who have obesity. They say, `Don’t come back to me and tell me your back hurts or you have acid reflux or high cholesterol until you will do something about it,’” laments Kahan, who is teaching medical school students to motivate patients.

What about the overweight? The task force said more study is needed on how best to help them.

But in Reno, Nev., Dr. Andy Pasternak calculates BMI for every patient at his family medicine practice _ and particularly targets the overweight in their 40s and younger for fitness counseling. He says if they wait until they’re heavier or older to get active, arthritis exacerbated by the pounds will be another barrier.

Patients seldom know what their BMI should be, but “at least twice a day people say, `What should be my optimal weight?’” Pasternak says.

He thinks saying to lose 60 pounds is too discouraging: “What I try to get them to focus on is: How much are you working out? How many servings of vegetables do you get a day?”


EDITOR’S NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


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