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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C24 Bariatric Times • December 2016 • Supplement C expanding coverage to deliver care to patients. Coverage should be available for drugs, surgery, counseling, and IBT. IBT should be expanded beyond the primary care setting. Medicare does not cover pharmacotherapy for obesity (it does cover IBT for obesity) and this is a problem as obesity drugs are emerging as an important element of care. Even when obesity drugs are covered, it is typical to reimburse for monotherapy, which in some patients may not be the most effective course of treatment. Obesity is a complex disease and may respond better to dual and triple therapies. In the treatment of other disease states, such as cardiovascular care or pain medicine, the benefits of combination therapy have long been recognized. In these cases, a single medicine need not be "maximized" before additional medications are added—a drug can be added to monotherapy to enhance benefits or treatment can be initiated as combination rather than monotherapy. Obesity is not just a disease; it is a chronic disease. Even when providers are open to obesity treatment, they may not regard it as a chronic condition. For example, obesity should be recognized as the same type of chronic condition as diabetes or hypertension. This represents a paradigm shift not only in the minds of many PCPs but also in how patients should approach and tackle weight loss. A patient who has been successful in weight loss must be regarded as suffering from chronic—but controlled—obesity. Helping patients to understand the fact that this is a chronic, even lifelong condition, may help patients deal better with long-term treatments, possible setbacks (relapses, weight gains), and the need to continue care even if the patient changes providers. It is also important to convey to patients that their end goals are improved health, not a specific number on the scale or percentage of body fat or BMI score. Patient education is also crucial. For example, many patients are disappointed when they "plateau" after a period of weight loss. Rather than seeing this as a setback or a negative, the clinician should frame it as a positive. Plateauing with weight loss means that the patient is maintaining weight loss—not regaining weight. This is an expected and positive benefit of weight loss programs and must be described as such to patients so that they understand both weight loss and maintenance of that weight loss are positive. Many patients who want bariatric surgery may not qualify for any number of reasons—their BMI may be too high, comorbid conditions may contraindicate surgery, they may not be an appropriate candidate, lack coverage, and so on. For these patients, other types of less invasive surgical interventions may be of great benefit. There is an urgent need for more versatile devices that may accommodate the needs of patients who need but might otherwise be precluded from conventional bariatric surgeries. Thus, the development and market clearance of novel intraluminal devices represent an important new area for innovation to treat obesity. CONCluSION The PCP is on the frontlines of the obesity epidemic. Although a typical primary care practice may not be equipped to manage the interdisciplinary care needed to effect and sustain significant weight loss, PCPs can network with other local experts, learn from published guidelines, and offer care for their patients with overweight and obesity from their "medical home." Patients may be indicated for anti- obesity drugs, procedures, and even surgery at much lower weights than many PCPs realize and they may benefit from these earlier rather than later interventions. Furthermore, many patients with overweight and obesity are indicated for drug, device, and surgery treatment—which may be covered by their insurance—but do not know about these options that may be highly beneficial to them. To that end, the role of the PCP in bringing state-of- the-art care to patients with overweight and obesity is paramount and unprecedented. Insights into the Patient Population with Obesity: Assessment and Treatment u

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