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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Page 13 of 26

C14 Bariatric Times • December 2016 • Supplement C obesity-related conditions in an individual patient can help shape treatment options. Moreover, patients present with different genotypes, comorbidities, and familial situations. When treating any patient with obesity, it is important to individualize treatment and recognize that this is not a "one size fits all" disease. When creating a treatment plan, it is helpful to take a detailed patient history with an emphasis on those weight loss efforts in the patient's past that met with success and those that did not. Patients vary in how they respond to different treatments, and patients may not be able to maintain certain types of interventions. The patient's medical and pharmacological history should be taken as well and any drugs that might promote weight gain should be neutralized (rotated to more weight- neutral agents) as much as possible. The patient and clinician should discuss factors in the patient's life that might hinder weight loss and methods of support. For example, the patient's lifestyle, work schedule, family situation, like or dislike for physical activity, interest in sports, food preferences, and cooking skills may all play a role in what sort of weight loss strategies will meet with most success. Patients may also have a number of resources that can be employed to advance and support weight loss, such as support of the significant other or friends, interest in new activities, positive body image, important functional goals, and improving overall well- being. Milestone goals may also be important, such as losing weight for a big life event or being healthier to accomplish certain goals. By the same token, if a clinician can work with a patient to identify weight loss barriers from the past— particularly those the patient did not recognize previously—this may create a breakthrough for the patient to start losing weight. Barriers might range from erratic schedules, intense food cravings, overeating at social events to dislike of physical activity, emotional eating, and alcohol consumption leading to overeating. When assessing what worked for a patient in advance, clinicians may wish to explore with the patient all of the things that helped him or her lose weight—even if that weight loss was not maintained long term. These methods (e.g., specific diets, exercise plans, lifestyle modifications, gym memberships, recipes, exercise buddies) can still be used to help lose weight, perhaps with other signal-interrupters layered on top. It is also important for clinicians to know the methods that did not work well for the patient. These methods—specific diets, exercises, drugs— should be avoided because they failed in the past and may waste time and discourage the patient. Evaluating success and failure for a patient requires careful attention in that sometimes the patient's response owes purely to physiology (e.g., a patient may respond to one drug but not another). In other cases, the patient might not have been adherent. Some efforts that failed previously might work the next time if the patient's situation has changed (e.g., a patient whose work schedule has eased up may now find it easier to incorporate exercise into his or her daily routine). The profound lifestyle changes needed to support a weight loss program may seem overwhelming to a patient; some may not be able to make these changes at all and others may make them but fail to sustain them for the long term. For example, a busy single mother with a long commute and a demanding job may find it difficult to shop for healthy foods and eat sensibly every day. To be successful long term, interventions must be sustainable and maintainable for the patient, and that includes considering their lifestyle as well as their physiology. The identification of barriers to success may be as crucial to success as recognizing the patient's key support structures. CreATe A PlAN TOGeTHer The patient's readiness for change determines the kind of plan to be developed and the most appropriate type of patient education. In other words, a patient who is ready to take decisive action is in a very different mental and emotional state than a person who has yet to fully appreciate the consequences of obesity. Sometimes patients may understand the risks of obesity and even contemplate the potential ramifications of their Insights into the Patient Population with Obesity: Assessment and Treatment

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