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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C16 Bariatric Times • December 2016 • Supplement C terms of what is working, what is not working, or what new tools or techniques might be beneficial at any given time. Monitoring progress can also be a way to reward, educate, and encourage patients. Over time, it is easy for a patient to lose momentum in a weight-loss plan and charting progress can be a way to restore enthusiasm and determination. TeCHNOlOGy Technological tools play an increasingly important role in weight loss plans. It can reduce the time burden required of a primary care physician for an intensive lifestyle intervention and it can also enhance patient engagement, which, in turn, may result in a higher degree of patient participation and commitment. With the rise of smart phones sometimes eclipsing laptops and home computers, clinicians should be aware of the many phone apps available that can help patients track and monitor their nutrition/dietary intake and physical activity. Furthermore, the data and reports offered by smart phone apps can be quickly and easily reviewed by PCPs. Apps can help track caloric intake or macronutrient content (e.g., protein versus carbohydrate). Since smart phones have become so ubiquitous, it is not difficult for patients to track their diet and activity continuously, wherever they are. PCPs managing patients with obesity need objective data to help monitor the patient and adjust their plans to meet their changing needs; these data are very easy to capture with smart phone apps. On the other hand, connectivity platforms are particularly important for weight-loss maintenance. Connectivity technology offers the patient a personal portal (which can be launched on a smart phone or a computer) in which they can enter specific data, that can then be utilized by the PCP. For example, patients may be asked to rate each day as green, yellow, or red in a stop-light pattern. The PCP can then ask the connectivity software which patients have had four or more "red days" in the past two weeks and then send out a specific email or text message to those patients asking if they might need to come in for a visit earlier than their next scheduled appointment. Thus, the portal allows the physician to empower patients to take the necessary action to get help sooner. It is not unusual for patients with obesity to regard obesity as "their problem" and avoid seeking medical help until they have the problem more under control—when actually the converse is beneficial. Patients with obesity who are struggling benefit from more rapid intervention, and portals can allow PCPs to encourage this behavior. Smart scales, activity monitors (accelerometers), and sleep monitors are all important devices to help collect objective data for the PCP to use to help guide the patient and encourage the most effective course of treatment. The frequency with which a patient weighs him or herself varies by the individual, and it may be important to empower the patient to take charge of this schedule. Many physicians recommend that a patient weigh him or herself at least once a week. In some cases, more frequent weighing (even for a short period of time) can give the patient some insight into the normal weight fluctuations that can occur so that they are less anxious with occasional slight weight gains. For example, those who weigh themselves frequently find that they weigh less in the mornings than in the afternoons. A systematic review of the literature (n=19 trials, 22 articles) found that regular self-weighing on a daily or weekly basis was found to improve weight outcomes. 42 This might be particularly important as daily weighing is much less labor intensive than keeping detailed diaries. Activity monitors, which are even available in waterproof versions for those who exercise in the pool, can help inform the physician how much the patient is exercising and it can also help educate the patient in terms of how much exercise is required for optimal weight loss and/or weight maintenance. A recent systematic review and meta-analysis found these devices were associated with increased physical activities in patients with overweight and obesity. 43 Sleep monitors can be very important for managing patients with obesity in that they provide the physician with good baseline information on the patient's quality and quantity of sleep, both of which can affect weight Insights into the Patient Population with Obesity: Assessment and Treatment

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