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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C20 Bariatric Times • December 2016 • Supplement C O besity therapy should be offered around the paradigm described as the 5-A's (see Table 5). 45,46 Broaching the subject of weight loss to a patient with obesity can seem daunting to a healthcare provider and may at first feel awkward, but patients likely recognize that they need help and may actually welcome the conversation. It is incumbent on the healthcare provider to take that first step in bringing up the subject, allowing the patient room to decline to discuss it. Many patients will actually welcome the chance to discuss the subject, particularly if they do not have to make the first move. Despite the fact that healthcare providers may initiate these conversations, they often do not. The reasons for avoiding this conversation are numerous and may act as barriers to care. Many busy practitioners simply lack the time to discuss obesity, particularly if the patient does not directly ask about it. Some clinicians may be willing to discuss obesity but feel that they lack the expertise, skills, or resources to do much about the patient's weight and avoid the topic because they have no ready answers. Patients may sometimes seem to avoid the topic possibly because they are embarrassed about their weight or feel ashamed that they cannot "control" it themselves, and clinicians take this as a clue to not "embarrass them" about weight loss. A major part of obesity management success can be attributed to patient engagement. Patients who are genuinely engaged with wanting to lose weight may be considered ready for change. Those patients who seem more ambivalent or dubious about weight loss lack the readiness for change needed to sustain the demands of IBT for obesity. Clinicians should assess the patient's readiness for change at the outset, around the initial "ask" phase when the topic of obesity is first introduced. If the patient is reticent to discuss weight loss or disengaged on the topic at first, the clinician is not remiss to bring the subject up again at later visits. A patient's readiness for change can increase over time and with reflection. The clinician should not force the discussion or be intrusive. During this discussion, if the patient appears at least willing to talk about obesity, the clinician can bring up some basic general strategies and see how the patient responds. For example, the clinician might suggest giving up sodas or increasing the amount of walking done each day. PCPs interested in initiating the conversation about obesity may be able to launch a discussion based on the patient's comorbidities. For example, a patient who seeks medical help for uncontrolled diabetes offers the physician an excellent opportunity to explain how closely diabetes is related to extra weight. Patients complaining about joint pain, for example, may open the door to a discussion on their obesity. A crucial component in this approach is that obesity should be medicalized—it is not a cosmetic problem or a moral failing or a lack of willpower—on the Insights into the Patient Population with Obesity: Assessment and Treatment starting the conversation about obesity Christopher D. Still, DO, FACN, FACP Medical Director, Center for Nutrition and Weight Management; Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania

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