Longevity
Three family doctors on what actually moves the needle in obesity care
By Life and Health Today Staff, . Life and Health Today.
Obesity care tends to stall not because the clinical targets are wrong, but because the plan never fits the patient's actual life. That is the shared premise behind a Medscape report on goal-setting in primary care, which drew on three family physicians working in different parts of the country.
What the scale misses
Natasha Bhuyan, a family physician with One Medical Group in Phoenix, told Medscape that weight and body-mass index are starting points, not the whole picture. Blood pressure, blood sugar, sleep quality, and mobility all belong in the conversation alongside them. The American Diabetes Association's 2026 guidance, cited in the report, takes a similar position: check body-mass index at least once a year, review the patient's full clinical picture, and build an individualized care plan from those findings.
Bhuyan uses color-coded action plans borrowed from asthma care, where green, yellow, and red zones tell a patient exactly what to do at each level of a reading. Applied to obesity-related conditions, the same logic lets patients act on their own data between visits. "Patients with diabetes can often self-titrate their insulin based on blood sugar numbers," she told Medscape.
Her framing of the doctor-patient relationship is deliberately asymmetric. "I tell patients that health is a journey, and they are the driver while I am the passenger," she said. "Sometimes, I can give them direction and guidance, and I can support them through conversation. But they are ultimately in charge of the direction that the car goes."
Getting patients who have drifted away back on track
Mike Sevilla, a family physician with Salem Family Care in Salem, Ohio, described a common starting point: patients who have not seen a doctor in a year or more. For them, he begins with familiar numbers from a blood panel, cholesterol and blood sugar, then adds weight and body-mass index as reference points.
Waist circumference is another measure he introduces early. The National Heart, Lung, and Blood Institute, as cited in the Medscape report, puts the healthy range at a waist circumference of 35 inches or under for women and 40 inches or under for men. For blood pressure, Sevilla gives patients a single number to remember: 120/80 millimeters of mercury.
For sustained motivation, he points patients toward health journals and wearable trackers. "Many of my patients wear health trackers and have apps on their smartphones to keep them focused," he told Medscape.
Why knowing the patient's life matters more than the protocol
Jesus L. Lizarzaburu, a family physician at TPMG Grafton Family Medicine in Yorktown, Virginia, makes the case that clinical targets mean little without social context. "Know your patients: their family situation, their job situation, any challenges they might be facing, such as taking care of an elder parent," he told Medscape. A patient already stretched by caregiving responsibilities does not need another obligation added to their week.
Lizarzaburu uses a different lever once he understands a patient's circumstances: he asks who matters most to them. "Many times, it is a child or grandchild," he said. He then asks the patient to stay accountable for that person's sake, and suggests placing photographs of those loved ones in places where food decisions get made.
All three physicians point to regular follow-up appointments as the structural backbone of the approach. Bhuyan described scheduled check-ins as accountability checkpoints that patients can anticipate and prepare for. "Health is quite complex," she told Medscape.
None of the physicians cited in the report had disclosed financial conflicts. The report describes a clinical framework, not a study with a control group, so it does not establish that any of these approaches produces better outcomes than standard care. What it offers is a set of practical strategies from working clinicians, grounded in existing guidance from the American Diabetes Association and the National Heart, Lung, and Blood Institute. Whether a particular approach fits a given patient is a question for the clinician who knows that patient's history.
Life & Health Today provides information for educational purposes only, not medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional.