I’ve just got to share the sheer joy and reward I’ve recently experienced facilitating yet another chat-based online weight loss group for the program called vtrimonline.com.

Picture this: It’s Tuesday evening at 7pm ET. Somewhere between 10 to 20 people who range in age, health concerns and pounds to shed; log on to the vtrimonline website for one of our 12  weekly chats. No phones, no cauliflower ears or hoarse voices. Just our fingers!

During the hour I, as the registered dietitian facilitator, get group members to share their weeks’ weight loss wows and woes (with no mention of pounds lost). I deliver key content to help arm people with nutrition, fitness and psychological expertise to lose weight and (hopefully) keep it off. Topics range from how to get moving more each day, to tactics to deal with emotional eating, to healthy choices when eating out, and much more.

A few facts are crystal clear:

• Myriad adults would improve their health status and potential longevity by losing a few pounds. Five percent seems to be the magic number to reap health benfits.
• Two thirds of adult Americans are overweight or obese, including many Medicare beneficiaries.
• Losing weight, even a few pounds, and keeping those pounds off is tough work which requires tenacity.
• Primary care providers (PCPs), including general and family practice physicians, nurse practitioners, physicians assistants and others; aren’t known for addressing or spending the time it takes with clients to counsel them on weight control. (In all fairness, they haven’t been allotted the time until now.)
• Susan Yanovski, MD, in her 11/24/11 New England Journal of Medicine editorial Obesity Treatment in Primary Care – Are We There Yet? (abstract), stated: “less than 50% of PCPs report consistently providing weight-control advice to adults and less than 25% report regularly referring people to other providers who may help them with weight control.”
• It’s well known that PCPs receive a minimumof nutritional science in training and it’s highly unlikely that many have obtained the skills known to be effective in weight management counseling from studies on long term weight management.

Yet despite these facts, on November 29th, Medicare (Centers for Medicare and Medicaid Services) announced in their Decision on Intensive Behavioral Counseling for Obesity that it will start to cover obesity counseling services when provided by PCPs (as defined by CMS).

Let's kick this off with THE TRUTHS about how challenging it is to keep lost pounds, just that, lost. It’s a tough job, in fact tougher than taking off those unwanted pounds in the first place.

Research shows that the most weight people lose, even with pretty constant expert support, is about 6 to 10% from your starting weight. Example: 200 pounds that's 12 to 20 pounds. Doesn’t sound like much compared to those triple digit losses touted on Biggest Loser or from for-profit diet plans. Research also shows people lose these pounds by about 6 months to 1 year max. It’s simply tough to lose more weight.  For sure there are exceptions. Read Weight Loss, Control: Expectations vs. Research-based Realities.

In the era of the Biggest Loser, the ante for pounds to expect to loose per week has gone up, not that the number ever approached realistic, even before Biggest Loser. People have long had unrealistic expectations for weekly loss - 3, 5, 10 pounds - feed by overpromising diets. Simply AIN’T GONNA HAPPEN if you’re following a sane and sensible weight loss plan!

On 5/13 President Obama, in his effort to keep healthcare reform on the front burner, sent a few deputies on a mission: find the best private-sector employee wellness and prevention practices in an effort to help other companies and federal workplaces implement these. I bet one of best practice that will be an element of each success story will be programs utilizing technology-based solutions (telephonic, intranet, internet, hand-held device, etc.) to provide frequent and chronic support.

A key, yet woefully underreported, conclusion to many health behavior change studies in the areas of weight, diabetes and/or blood pressure management; point to the importance of consistent and continuous support over time. This has evolved to be an essential component to help people achieve their health goals and support their efforts to continue practicing new found healthy lifestyle behaviors.