Counselors Within the Chronic Care Model: Supporting Weight Management

The prevalence of obesity, especially in industrialized nations, has continued to rise over the past decade along with the negative sequelae associated with the disease (World Health Organization, 2010). Obesity is highly correlated with many costly and chronic medical conditions, such as metabolic syndrome, diabetes, and heart disease. Although its root causes continue to be investigated, obesity is generally recognized as a multifactorial disease with psychological, physiological, social, and environmental contributors. Because of its high correlation with serious disease processes, obesity is often described as a "chronic disorder requiring long-term care" (Wadden, Brownell, & Foster, 2002, p. 516). As with many other chronic health conditions, the treatment of obesity is not particularly suited to the standard health care system developed around the diagnosis and treatment of acute conditions and symptoms. Instead, the treatment of obesity, with its multifactorial etiology, is better suited to a multidisciplinary, comprehensive, and collaborative approach involving health care practitioners from diverse disciplines. The Chronic Care Model (CCM), a comprehensive collaborative health care approach developed for the treatment of chronic diseases such as diabetes, is particularly appropriate for the treatment of obesity (Bodenheimer, Wagner, & Grumbach, 2002a, 2002b; Chen & Bodenheimer, 2008). Structurally, the six basic components of the CCM (discussed later) provide a framework for the treatment of obesity by a supportive team of health care professionals (Glasgow, Tracy Orleans, Wagner, Curry, & Solberg, 2001). In this article, I elaborate on the vital and essential role of mental health counselors within each of the six components of the CCM for the treatment and management of obesity: (a) health care organization, (b) delivery-system design, (c) clinical information systems, (d) decision support, (e) client self-management support, and (f) community resources. I briefly summarize the CCM and then explain the role of the mental health counselor vis-a-vis the six components. The CCM components of decision support, client self-management support, and community resources are emphasized because mental health counselors can function with a high degree of autonomy in these areas. Finally, the expanded involvement of mental health counselors in the treatment of obesity is advocated. The focus of this article is limited to the role of mental health counselors supporting clients with obesity who have elected to seek treatment in a primary care setting for weight management. It must be acknowledged, however, that many individuals with obesity are healthy metabolically and that some researchers have even shown a degree of overweight to be associated with greater longevity (McGee, 2005). In the same vein, Bacon and Aphramor (2011) of the Health at Every Size movement presented evidence supporting the distinction between obese individuals with and without conditions such as metabolic syndrome, insulin resistance, and heart disease. Additionally, although this article contains several references to "obese clients" and/or "obese individuals" consistent with medical research terminology, I fully support the use of "people-first language for obesity" advocated by the Obesity Action Coalition (para. 1). Definitions Related to Obesity and Prevalence The Centers for Disease Control and Prevention (CDC; 2015) defines overweight as a body mass index (BMI) greater than or equal to 25 kg/[m.sup.2] but less than 30 kg/[m.sup.2]. Obesity is defined as a BMI greater than or equal to 30 kg/[m.sup.2] and is additionally divided into Grade 1 (BMI = 30-34 kg/[m.sup.2]), Grade 2 (BMI = 35-39 kg/[m.sup.2]), and Grade 3 (BMI > 40 kg/[m.sup.2]; World Health Organization, 2000). During 2011-2012, more than two thirds (68.5%) of adults in the United States were either overweight or obese, 34. …