Obesity Practice Considerations

1
Obesity Practice Considerations
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Establish an Approach to the Obese Patient

• The patient who has a disease but is not the
  disease
• Medical and psychological benefits to the patient
• Personal challenge and economic opportunity for
  the patient
• Professional challenge and economic opportunity
  for the physician

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Establish an Approach to the Obese Patient
(continued)

• Put Prevention into Practice (PPIP) Office
• Organizational commitment
• Clinicians attitude
• Staff support
• Establish polices and protocols
• Use office tools effectively to teach and treat
• Delegate tasks

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Obesity is a Medical Disease to Be Treated by
ProfessionalsUsing Medical Tools

• Shared Decision Making Model
• Match the tools with the task, the treatment with
  the patient
• Medical
• Psychological
• Diet
• Cognitive-Behavioral
• Physical Activity
• Surgical

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The Office Environment
Physical Environment

• Accessibility and comfort are key
• Large doorways, hallways, restrooms
• Seating
• Sturdy, armless chairs and high, wide, firm sofas
  19 high
• Reading material and artwork
• Neutral (non-food, thinness, glamour related)
• Promotional materials for office products,
  services should be professional without sales
  pressure

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The Office Environment
Example of Waiting Room
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The Office Environment
Equipment

• Large adult thigh and blood pressure cuffs, large
  tape measure
• Large exam tables and gowns
• Scales that weigh up to 500 lbs or more
• Exam tables
• Sturdy, wide and bolted to the floor to prevent
  tipping

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The Office Environment
Materials

• Educational and behavioral brochures
• Pamphlets and handouts on BMI, obesity associated
  diseases, diet, exercise, medications, and
  surgery
• Journals to help record food intake, emotional,
  physical activity, snacks, etc.

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The Office Environment
Tools

• Pre-visit questionnaires
• Screening for anxiety, depression, nocturnal
  binge eating, etc.
• Weight loss graphs
• Pedometers
• Body composition analysis, metabolic rate
  testing, laboratory tests

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The Office Environment
Protocols

• Patient care treatment protocols for
• Treatment problems
• Side effects
• Complications
• Medication use
• Exercise program

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Staff

• The cornerstone of effective obesity treatment
  is grounded in skillful and empathetic
  physician-patient communication
• - The Therapeutic Bond
• Empathetic, compassionate, supportive,
  trustworthy, nonjudgmental, caring
• Optimistic hope is an important medicine
• Healthy role models, helpful, kind

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Treatment Process

• Diagnosing the problem
• Foods
• Moods
• Behaviors
• Emotional eating patterns
• Anxiety
• Depression
• Nocturnal binge eating

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Treatment Process (continued)

• Agree on treatment expectations, goals
• 1 of total weight loss per week
• 10 weight loss goal
• Biomarkers
• Establish and maintain behavior and lifestyle
  changes

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Treatment Process (continued)

• Use tools to foster change
• Pedometers
• Eating activity journaling
• Lab tests
• Body measurements
• Medications
• Medication changes
• Establish a long-term relationship through
  structured follow-up visits to obtain a safe,
  significant, and sustainable healthy weight

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Referrals

• Nutritionist
• Behavior therapist
• Psychiatrist
• Bariatric surgeon
• Malpractice Have it, but a good supportive
  doctor-patient relationship with good, clear
  communication is the best protection against
  being sued