Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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Bariatric Times • December 2016 • Supplement C C13 T here are a number of tools for helping patients with obesity and it is important for clinicians to be familiar with all of them and use them appropriately. The first crucial step in dealing with obesity is to be able to reliably and accurately identify patients with overweight and obesity. The body mass index (BMI) is a useful tool, and waist circumference has emerged as an important metric and is easy to obtain in the office with a simple tape measure. Knowing the patient's total weight and excess weight in percentages can also be useful pieces of information. Body composition may very helpful and can be ascertained in a number of ways, such as bioelectrical impedance or other systems. When treating patients with overweight or obesity, it can be meaningful to the patient to calculate his or her percentage of body fat, visceral fat, and fat-free mass or skeletal muscle mass as numbers to better understand what excess fat really means. For patients on weight loss programs, these same numbers can help them gauge progress beyond just the total number of pounds lost on the scale. During weight loss programs, care must be taken so that patients do not lose much lean skeletal muscle mass. Clinicians should track this closely, as lean skeletal muscle is a major contributor to the patient's metabolism and is best preserved as much as possible. Thus, clinicians should look into both weight and body composition as variables to track in the patients and as measures that should be explained to the patient to understand weight loss progress. Staging systems, such as the Edmonton Obesity Staging System, 15 allow for an easy way to categorize the relative severity (and with treatment improvement) of the patient's condition. These staging systems present a more fully dimensional view of the patient's health by going beyond the weight and looking at other factors, including comorbidities, functional abilities, physiology, and their risk factors for other diseases. The Edmonton Obesity Staging System is a valuable tool, can be learned quickly, and is easy to incorporate into everyday clinical practice. Biomarkers for response to obesity treatments are not part of routine clinical practice today but hold great promise. 36 Biomarker testing, for example buccal swabs for quick in-clinic testing, may be available in the future to better assess risk for patients or to determine if a patient might respond well to a particular AOM. Other testing may involve the gut microbiome to determine the most appropriate candidates for specific surgical interventions. Indeed, the gut microbiota may play an important role in metabolism that is only beginning to be elucidated. 37 OBeSITIeS NOT OBeSITy There is not one single type of obesity. Obesity is associated with numerous health conditions, comorbid disorders, and can have an adverse effect on conditions as diverse as pancreatitis or gallstone disease, 38 temporomandibular disorders, 39 chronic pain syndromes, 40 and profound psychological distress. 41 Understanding Insights into the Patient Population with Obesity: Assessment and Treatment translating the recommendations into action! Deborah Bade Horn, DO, MFOMA President, Obesity Medicine Association; Medical Director, Clinical Assistant Professor, Center for Obesity Medicine and Metabolic Performance, UT McGovern Medical School, Houston, Texas

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