We examined the effect of an outpatient office-based diet and exercise counseling program on weight loss and lipid levels with an onsite dietitian who sees patients at the same visit with the physician and is fully reimbursable. Eighty overweight or obese patients (average age 55 ± 12 years, baseline body mass index 30.1 ± 6.4 kg/m 2 ) with ≥1 cardiovascular risk factor (86%) or coronary heart disease (14%) were counseled to exercise 30 minutes/day and eat a modified Dietary Approaches to Stop Hypertension (DASH) diet (saturated fat <7%, polyunsaturated fat to 10%, monounsaturated fat to 18%, low in glycemic index and sodium and high in fiber, low-fat dairy products, fruits, and vegetables). Weight, body mass index, lipid levels, and blood pressure were measured at 1 concurrent follow-up visit with the dietitian and physician and ≥1 additional follow-up with the physician. Maximum weight lost was an average of 5.6% (10.8 lb) at a mean follow-up of 1.75 years. Sixtyfour (81%) of these patients maintained significant weight loss (average weight loss 5.3%) at a mean follow-up of 2.6 years. Average decrease in low-density lipoprotein cholesterol was 9.3%, average decrease in triglycerides was 34%, and average increase in high-density lipoprotein cholesterol was 9.6%. Systolic blood pressure was lowered from 129 to 126 mm Hg (p = 0.21) and diastolic blood pressure from 79 to 75 mm Hg (p = 0.003). In conclusion, having a dietitian counsel patients concurrently with a physician in the out-patient setting is effective in achieving and maintaining weight loss and is fully reimbursable.It has been reported that the average American makes 3 visits per year to office-based physicians. 1 More than 62% of these visits are made to patients' primary care physicians. 2 In the Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted by state health departments, <50% of obese subjects reported receiving advice to lose weight. 3 Nevertheless, receiving advice to lose weight was strongly associated with attempts to implement that advice. Rates of counseling about physical activity may be even lower. Nationally, the reported rate of physician counseling about exercise is ~34%. 4 However, many clinicians do not routinely measure patients' weight, assess their lifestyle, or offer advice on such topics. The main reasons for such low levels of clinician involvement are most often attributed to their lack of training in these areas, insufficient time for counseling in practice settings, an absence of clear guidelines and practice tools, scarcity of patient education materials, and minimal to no reimbursement. 1 In the present report, we describe our results with an onsite dietitian, who sees patients at the same visit with the physician and is fully reimbursable, on weight loss and lipid levels.
