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 C15 disease, but may not yet be thinking seriously about making any lifestyle changes. The patient's plan should include a readiness assessment, metabolic and laboratory assessment, contact time, the identification of patient and community resources to support weight loss, realistic goals, patient education (metabolic adaptation/chronic disease progression and potential for regaining weight), and a system to monitor the patient's progress. The purpose of the metabolic and laboratory assessment is mainly to identify the patient's potential comorbidities so that they may be proactively addressed. For example, patients with T2DM may require a somewhat different approach to weight loss than those who do not have this disease. Frequent contact between patient and clinical team may be very helpful to the patient's success. Thus, the more often the patient can come into the clinic for face-to-face visits, the better his or her chances become for success. The challenge with contact time is logistical—how to manage such frequent interactions successfully in already busy clinical practices and how to convince patients to dedicate the time to frequent office visits. The typical primary care practice has a workflow and practice paradigm that is not well suited to manage complex disease models such as long-term obesity care. Comparing this to heart disease— which is often managed by cardiologists using community and outside resources that may even come to the patient (as well as the patient going to the clinic)—obesity is not often as optimally treated. Patients with obesity may require resources that exceed the scope of what is available within the primary practice setting, so it is important for clinicians to be aware of the expert resources available to them and their patients within the community and beyond. For example, a PCP need not have a dietitian on staff to be able to offer patients dietary guidelines. If the patient requires advanced care in terms of diet, the PCP should be able to refer the patient to a local dietitian. Thus, PCPs should identify local resources for diet, exercise, psychological care, and other support for their patients with obesity. Intensive counseling is often helpful for patients with obesity but few PCPs are equipped to manage this type of care; for that reason, the PCP should become familiar with local resources and confident about referring patients to this kind of care. Moreover, the ability to refer patients to local experts allows a general practice to offer an outstanding program without having to manage all of the services under one roof—an impractical situation even for a very large practice. As has been the case with heart disease and other complex conditions, community integration may become an important element in obesity care. However, the big difference in heart disease and obesity is that obesity is not the sort of condition that results in a sudden trip to the emergency department, which may explain why obesity is often viewed as a less serious physical condition than heart disease. Goals are vital to help patients understand their objectives and to chart their progress. The most workable goals in this regard are realistic, short- term, manageable goals rather than extreme goals that may leave the patient discouraged rather than motivated. While there is nothing wrong with setting long-term goals, which can be very powerful to the patient, they can be overwhelming as the patient struggles with day-to-day matters. Thus, breaking up the big goals into manageable short-term goals can be a good way to incentivize the patient to keep pursuing his or her ultimate objective. Patient education is an important component of any successful weight loss plan. As early as one of the very first visits, the clinical team should discuss with the patient the concept of metabolic adaptation to obesity and chronic disease progression. Obesity must be considered a chronic disease, and patients should be made aware that they will never entirely overcome obesity. Furthermore, patients should realize that weight re-gain is not uncommon among patients with obesity, even among those who successfully lost large amounts of weight. Yet in such cases, weight loss still appears to benefit the patients, even if they relapse and gain back part or all of the weight. Any plan requires a way to accurately chart progress and provide the patient with feedback in Insights into the Patient Population with Obesity: Assessment and Treatment

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