RobardUser Robard Corporation | August 2017

How Being a Physician Living with a Chronic Disease Impacts my Work with Bariatric Patients



“You can make $20 per stool sample?” You would have thought I had won the jackpot! I just thought my colleagues and I were getting one over on the “Diarrhea Clinic” in Guadalajara, Mexico. I attended medical school there and was making a habit of “donating” regularly. What I did not realize was that I wasn’t just suffering from “Montezuma’s Revenge.” It wasn’t until I returned home that I learned I had Crohn’s Colitis, an often debilitating inflammatory condition of the GI tract characterized by abdominal pain, diarrhea, and rectal bleeding. It can often result in multiple surgeries to remove diseased colon and worse, colon cancer.

I spent the next several years on different medications including monthly infusions and weekly injections, all of which had many side effects. During my residency, I spent 10 days in the hospital due to a flare that resulted in over 20 abnormal stools per day, anemia, and almost constant pain. Despite this, I returned to my career determined to not let this disease slow me down.

I became a family doctor and practiced in the primary care setting for nine years. During that time, I discovered a passion for bariatric medicine. This evolved out of a desire to keep myself healthy which required changes in my diet. I found that eliminating processed foods and added sugars, except those naturally occurring in fruits and vegetables, helped me to keep my colitis at bay. With the help of an excellent gastroenterologist, I healed and continued to enjoy excellent health for many years. However, this hasn’t always been easy and this is where bariatrics comes back into the picture.

Taking care of myself every moment of every day requires a lot of work. It means pushing myself to exercise even when I am exhausted. It requires eating salads and protein when others are enjoying pizza or ice cream. It requires actively engaging in positive thinking and using tools like meditation, cognitive behavioral therapy and affirmations to manage stress levels. And I don’t always feel like doing these things. These are exactly the same challenges that, on a day to day basis, my bariatric patients experience.

I find that using these tools myself adds an additional layer of empathy and relatability to counseling my patients that otherwise wouldn’t be there. They often greatly appreciate this and find that I am able to help in a very unique way because I “get it.” I share my story with patients because when a doctor is able to be vulnerable, they realize they are not alone and that anything is possible.

Every day, I continue to discover new and powerful ways to care for myself, mind, body, and spirit. As my practice continues to evolve, I incorporate as many of these amazing modalities as possible. I hired a mind-body medicine physician to teach yoga, meditation and other skills who has inspired many of my patients. I have a behavioral counselor who keeps us all on track. But most of all, my patients, staff and I are all just trying to be the best version of ourselves on this human journey. I still struggle regularly — as do my patients — but we all have found better ways to be in this world. And because of that, I have found this work far more gratifying than anything I could have imagined and I believe my patients are better for it.



Read More >>

Obesity — A Term that Carries a Lot of Weight. Should We Change It?



The idea of obesity is a difficult subject to broach on many levels. The term itself is loaded with stigma, and people who suffer from this condition can become resistant to even hearing the word, let alone talk about it. The shame and anticipation of judgement can be disabling, and yet the language we use when discussing weight is so limited. What can health practitioners do to break down the wall?

In a study published in a 2012 issue of the journal Obesity, researchers asked 390 obese adults in primary care settings in the Philadelphia area to complete a questionnaire about the terms that are most and least acceptable to describe excess body weight. Out of the 11 terms that were offered, “fatness” was rated as the most undesirable, followed by “excess fat,” “large size,” “obesity” and “heaviness.” (The most preferred terms were simply “weight,” “BMI,” “weight problem” or “excess weight.”)

These words encompass the majority of terminology currently used in health care to describe excess weight. But in an effort to change how physicians and patients engage with the topic of obesity, the American Association of Clinical Endocrinologists, or AACE, and the American College of Endocrinology, or ACE, have proposed a new diagnostic term to describe obesity: Adiposity-Based Chronic Disease, also known as ABCD.

“Right now, obesity is relegated to a simple construct of having a [body mass index] over 30,” says co-author Dr. Jeffrey Mechanick, a professor of medicine and medical director of the Kravis Center for Cardiovascular Health at the Icahn School of Medicine at Mount Sinai in New York City and past president of AACE. “But the word obesity doesn’t confer sufficient information about the disease risks.” ABCD on the other hand, focuses on a complications-centric approach to diagnosing, categorizing, and treating overweight.

The categorization takes into account a number of measures. In addition to BMI, this new system also takes into account the person’s waist circumference, waist-to-hip ratio, fat identified on advanced body imaging techniques such as ultrasound and MRI, and perhaps inflammatory markers on blood tests. The proposed model also includes three distinct stages:

Stage 0: The person is carrying excess weight but doesn’t have health complications from it.

Stage 1: The person is experiencing mild to moderate complications — such as prediabetes or slightly elevated blood pressure — due to excess body weight.

Stage 2: The person has more severe complications – such as type 2 diabetes or significantly high blood pressure – that are related to carrying excess weight.

What category a patient falls into would inform treatment, and would also increase the likelihood that a physician would focus on treating not just weight related complications, but also the excess body weight itself.

This new model will hopefully not only create a less biased way for physicians to engage with patients about their weight; it will also hopefully be a way for weight loss treatments to be more readily covered through insurance by having this new diagnostic term being incorporated into the medical coding structure — such as the ICD-10, or the International Classification of Diseases.

How we talk about obesity matters. And perhaps a better way to talk about obesity is to not talk about “obesity.” Not in the way people are used to hearing anyway. What are your thoughts?

Source: U.S. News


Blog written by Vanessa Ramalho/Robard Corporation


Read More >>

How You Discuss Weight with Patients is Just as Important as Treatment: Free Webcast



Good news: Medical providers are finally starting to address obesity and its impact on their patients’ overall health. Bad news: Without a standard to look to for how to discuss weight with their patients and what the best treatment options may be, providers run the risk of fat shaming their patients, leading to unintended negative effects.

A review of recent research presented at the 125th Annual Convention of the American Psychological Association looked at how unconscious bias against overweight patients can impact how physicians interact with them about their weight, leading to increased stress for the patient. This stress, combined with feelings of shame, can cause patients to delay treatment and even avoid interacting with health care providers altogether. While providers always mean well, the way in which patients are approached about their weight can make all the difference when it comes to discussing medical concerns with sensitivity.

With obesity only recently being identified as a disease — with links to more than 20 chronic conditions (and growing) that are still being researched — it’s hard to know the best way to proceed with overweight patients without a standard and clear medical protocols to refer to as guidance. You’ve taken the step in acknowledging the importance of addressing obesity with your patients, but where do you go from here?

First off, it is important to acknowledge that no one is the expert at everything. If obesity treatment is not something you have focused on in the past, there can naturally be a learning curve as far as how to discuss it with your patients, and how to move forward with treatment. Working with an experienced partner in weight loss can not only save you time, but it can also help you provide the highest quality care.

We invite you to begin learning about how to speak with your patients about their weight with our complimentary webcast, How to Speak to Patients About Obesity. Learn directly from other doctors and peers in the field about what works, so that you can continue to elevate your standard of care while saving yourself and your patients both time and money.

Good news: If you’ve committed to providing the best care to your patients by choosing to treat obesity, you’re not alone. And we’re here to help.


Source: Science Daily


Blog written by Vanessa Ramalho/Robard Corporation


Read More >>