CAM and Weight Loss: Does It Work?

Désirée A. Lie, MD, MSEd

Disclosures

March 27, 2013

In This Article

Do These Products Have a Place in Clinical Practice?

Case Conclusion: Mrs. Lin

Mrs. Lin is seeking an unproven and potentially harmful therapy, and education about the lack of evidence for any role of hCG in weight loss is indicated. First, she should be affirmed and congratulated for seeking information and wishing to achieve a healthy weight. Because she has been successful over several years in reducing her BMI, motivational interviewing, including eliciting strategies she has perceived to be successful in the past, is a reasonable approach to assess her current level of confidence and readiness to change.[19,20]

Once her stage in the readiness-to-change cycle is determined, the goal is to move Mrs. Lin step by step toward the next stage: from contemplation to action, or action to maintenance, for example. It is important to negotiate the best plan for her, including selecting from a menu of acceptable strategies that include lifestyle changes or weight management programs and allowing her to choose her preferred goals and rate of progress.

Case Conclusion: Mr. Ford

Mr. Ford is concerned about his body image but has a healthy exercise pattern. He, too, should be congratulated on his healthy lifestyle and desire to improve further. An online educational strategy may be of benefit, starting with Mr. Ford sharing with the provider information he has found about the products he wishes to try. The search can be extended by the provider to identify sites with evidence-based evaluation of the products. On the basis of the findings, the provider can then make recommendations about each product.

Indeed, patients often carry Web-accessible electronic devices, such as smartphones, that can be used in the clinical encounter. The "online on-the-spot searching" (OOS) technique[21] describes physicians conducting online searches with patients during clinical encounters. This very small study reported that physicians who were trained to use this technique were able to better meet patients' need for up-to-date information, and that physician training and practice reduced the time spent on searching to 5 minutes or less for a topic. Participants were reported to be in favor of incorporating OOS into patient visits, and the researchers concluded that almost one half of searches identified new information relevant to the physician. In one quarter of searches, the physicians changed their decision on the basis of the information discovered.

Waiting rooms may also provide computers with links to the best Web resources for patients to search while waiting. In the future, consumer-friendly summaries of systematic reviews will provide yet another resource for patients.[22] Bookmarking patient-friendly sites or providing a handout with the best Web resources for patients to evaluate new evidence using their electronic devices or home computers can also be useful.

The current roles of physicians and other healthcare providers have expanded to now include skills for helping patients access, critically appraise, and review online evidence, with the goal of identifying best sources for decision-making about interventions. In the area of obesity management, these skills are likely to save time spent counseling or advising against poor choices. However, studies are needed to demonstrate the effectiveness of supporting patient information management for improving outcomes and changing behaviors.

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