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 C9 C ustomized care, sometimes called precision medicine, attempts to help create specific treatments geared to the needs of an individual patient and this model is extremely relevant for obesity treatment. It also allows for the patient and clinician to intensify treatment as needed or to change it as the patient proceeds along the continuum of care. It allows for care to be more or less intensive at different phases of the patient's journey. There are four main domains of treatment. The least invasive of these is an intensive lifestyle intervention (ILI). The following can be added to ILI: anti-obesity pharmacological therapy (second domain), intermediate procedures (third domain), and finally bariatric surgery (fourth domain). All domains involve ILI, which must always be considered the foundation, and then medications, intermediate procedures, and bariatric surgery may be added. Healthcare professionals involved include the primary care physician (PCP) and integrated health support at first, followed by obesity specialists, and finally, in the fourth domain, a bariatric surgeon. INTeNSIve lIFeSTyle INTerveNTION Intensive lifestyle intervention (ILI) is the cornerstone of all obesity care. 18 It includes a comprehensive program of nutrition (diet), physical activity (exercise), a psychosocial component, sleep, and stress reduction. 19 Each of these components can be individualized for each patient. For example, nutrition must include caloric reduction and appropriate nutrition, but the exact diet and special needs for the patient will play a role and allow for the plan to be customized as needed. For example, some patients may have certain food allergies, need a gluten-free diet, prefer vegetarian meals, or enjoy certain types of foods. Patients may have physiologies that respond better to some diet plans than others. For example, some patients may do well on low- carbohydrate diets while others feel lethargic on the same diet. Special needs for individuals may also be accommodated with meal replacements for some patients or the use of artificial sweeteners for others. In short, the "one size fits all" approach to diet and nutrition is neither realistic nor effective. The same approach applies to the patient's physical activities. There is a wide range of physical exercises available including some that are gravity-mediated and may be easier for patients with obesity. Patients with obesity or those with mobility issues may benefit more from water exercises, others may experience more benefits from vigorous strength training, while others may need recumbent type activities to accommodate their limited movement. Psychosocial interventions, sleep hygiene, and stress reduction also can be individualized to best meet an individual patient's needs and be most effective. 20 A sleep history may be useful for treating patients with obesity, including not just the presence or absence of obstructive sleep apnea (OSA), but also sleep volume and quality. Poor sleep habits may change hormonal levels, Insights into the Patient Population with Obesity: Assessment and Treatment customizing obesity treatments Deborah Bade Horn, DO, MFOMA President, Obesity Medicine Association; Medical Director, Clinical Assistant Professor, Center for Obesity Medicine and Metabolic Performance, UT McGovern Medical School, Houston, Texas

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