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 C21 contrary, it is part of the patient's overall health picture. Obesity is a disease and should be treated as a medical problem. 47 Assessment of obesity should be done using the body mass index (BMI [required for reimbursement purposes]) and the Edmonton Scale. Patients may be unfamiliar with these systems, so the physician might explained them further. When discussing issues with the patient that might support or hamper their weight loss efforts, it is particularly crucial to recognize barriers that can block a patient's progress. These barriers are many and might include the following: patient education, mental health issues (e.g., depression, lethargy), social status (e.g., stress, overwork, chaotic family life), physical problems (e.g., thyroid dysfunction, comorbid conditions), emotional issues (e.g., sorrow, loss), socioeconomic factors (e.g., lack of access to healthful foods and exercise facilities), and others. It is more effective to identify and acknowledge these barriers (and to work around them) then it is to expect a patient to somehow "power through" them or "get over" them. Advising the patient about obesity risks is a component of patient education. A key point for patients to recognize is that even a relatively small weight loss carries with it substantial health benefits. Obesity management—both losing weight and sustaining that weight loss—are not "events" that are accomplished and then forgotten. Obesity management requires a long-term approach, with long-term strategies. Patients must accept and recognize that they will need to deal with this issue in one form or another for a long time, possibly for the rest of their lives. This leads to patient agreements. While clinicians often do well in terms of initiating a discussion about weight loss and educating patients, it is also necessary to work out a specific treatment strategy with the patient. Patients must agree not only on the need for obesity management but also on weight loss strategies, treatments, and expectations. The diet industry in America has created and fuels some highly unrealistic expectations about weight loss and patients are exposed to advertisements promoting rapid or extreme weight loss. Clinicians should address that subject with patients specifically and advise them that these claims are highly unrealistic and likely have more to do with marketing a product than promoting a realistic therapeutic goal. To maintain a patient's interest and engagement and to avoid discouragement, goals should be reasonably attainable. Again, a modest weight loss can be associated with significant benefits, so clinicians should emphasize that weight loss need not be dramatic or rapid for them to reap significant health rewards. Obesity can be challenging to manage even for the most motivated patients. Clinicians should help the patient along his or her weight loss journey by identifying drivers and acknowledging barriers. There are many resources available to patients: commercial diet plans, specialists (e.g., dietitians), exercise programs, and technology tools. Table 5. The Five A's of Obesity Management 4 5 STEPS ASK • Ask the patient for permission to discuss weight • Explore the patient's readiness for change A SSESS • Assess the patient's obesity class and stage • Assess for drivers (root cause), complications, and barriers ADVISE • Advise the patient of his or her obesity risks (related more to obesity stage than BMI) • Explain the benefits of modest weight loss, focusing on improving the patient's health and well-being • Explain the need for a long-term strategy to manage weight • Discuss treatment options AGREE • Agree on realistic weight-loss goals and expectations • Agree on a treatment plan ASSIST • Address drivers and barriers • Provide education and resources to the patient Insights into the Patient Population with Obesity: Assessment and Treatment u

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