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How I Treat Obese Patients in a Federally Qualified Health Care Clinic




Two of the most exciting parts being a physician working in a federally qualified health care clinic are providing medical care that I believe makes a difference and helps to put the patient in charge of their own health care, and helping my patients gain medical literacy. This includes discussing their weight.

Being overweight or obese is a gateway to an extensive variety of disease states across a multiplicity of organ systems. Obesity is a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.
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To both prevent and treat this disease, the field of obesity medicine is an exciting and growing field that is marrying new and evolving sciences, cognitive behavioral therapies, and mind-body medicine modalities.

I have made it a personal policy to discuss weight with 100 percent of my patients. In my primary care setting, where we have limited time per patient visit and I am seeing patients with multiple and chronic illnesses, it is really a matter of time and practicality. With the few minutes I have with each patient, what is the one thing that I can do or say that will have the biggest impact on my patients’ reduction of morbidity and mortality?

Having a conversation about weight with the patient saves me time and involves the patient in taking charge of their health. Talking to a patient about their weight and their BMI are crucial components in helping them to “buy in” and become a key player on their own healthcare team.

For example, here’s a sample of patient BMI ranges that I observed over a two-day period: I saw 31 patients with BMIs ranging from a high of 67.5 to a low of 15.1 with ages ranging from 18 to 66. 21/31 had BMIs of 26 (approximately 66 percent) or greater. Most of these patients were insured through the Affordable Care Act, Medicaid or Medicare.

My typical office visit goes something like this: My Medical Assistant brings the patient back into the exam room where vital signs are taken. Height and weight are entered into the electronic medical record at each visit and the BMI is automatically calculated. The patients see their vitals signs displayed before their eyes. When I enter the room, I briefly explain to the patient what they are seeing on the screen. For many patients this is a learning opportunity as I explain BMI and what the ranges mean. The majority of patients are curious. They want to know where they fall, how close they are to normal, etc. I then take a few minutes to explain that losing as little as 5-10 percent of their baseline weight can lead to exponential improvements in their health and quality of life. This is especially motivating for my patients who are:

1) Suffering from multiple comorbidities such as hypertension, hyperlipidemia, diabetes, and joint pain;
2) Tired of taking multiple medications and or being insulin dependent;
3) Tired of looking older than their chronological age;
4) Tired of being depressed;
5) Feeling like they are a victim and want to have a sense of something that they can do to contribute to their well-being.

I bring my patients back for more frequent office visits, generally every week to two weeks for an initial period of 12-16 weeks to provide the added support and accountability needed to support a patient on a weight loss journey. I have also familiarized myself with the current anti-obesity medications available and prescribe them for the appropriate patient, along with eating behavior modification and exercise prescriptions.

The other day a patient of mine returned for a weight check, delighted with another few pounds of weight loss. She exclaimed that her cardiologist stopped one of her anti-hypertensive medications, and she was smiling broadly — her dental hygienist told her earlier in the day that she looked like she was losing weight and looked good. She was near tears. She stated that her stress incontinence had improved so much that she was thinking about trying a beginner’s yoga class. This kind of success story has become an everyday part of my daily experience as a physician — and my own joy and satisfaction is priceless.



1."The Epidemiology and Determinants of Obesity in Developed and Developing Countries." http://econtent.hogrefe.com. International Journal for Vitamin and Nutrition Research, 14 Mar. 2013. Web. 25 Mar. 2017.


Blog written by Carol Penn, D.O.



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A New Solution for Burning Fat Could Be… Fat?



So fat is fat, and all fat is bad, right?

Wrong.

“Not all fat is equal,” says Professor Alexander Pfeifer from the Institute of Pharmacology and Toxicology of the University Hospital Bonn. Apparently, according to recent research out of University of Bonn, researchers have found a way to use what is called “brown fat” to burn energy from food and stimulate weight loss.

Humans actually have two different kinds of fat: white fat (which is the bad fat that makes our “love handles” that we want to get rid of) and brown fat which acts like a desirable heater to convert excess energy into heat. In essence, white fat stores energy, while brown fat helps the body burn energy through heat. In adults, people with higher amounts of brown fat have lower body mass, and according to studies, increasing brown fat by as little as 50 grams could lead up to a 10 to 20 pound weight loss in one year.

Using adenosine, a new signaling molecule typically released during stress, researchers at University of Bonn have discovered a way to activate these brown fat cells, and even turn white fat cells into brown fat cells, a process called “browning.”

More recently, scientists at the Gladstone Institutes identified an FDA-approved drug that can help create more of this brown fat. “Introducing brown fat is an exciting new approach to treating obesity and associated metabolic diseases, such as diabetes,” said study first author Baoming Nie, PhD, a former postdoctoral scholar at Gladstone.

Such a method of treating obesity is still in the research phase, and may not likely become a commonly accepted practice for some time yet. There are several potential side effects that may arise from taking the drug, and more development is necessary before human trials can be explored. Nonetheless, it is an exciting direction in the field of obesity treatment that healthcare professionals should keep a close eye on.

In the meantime, weight management is still an urgent need for so many across the country. For healthcare providers, there are already many effective ways to begin treating obesity. Learn more about how to start a weight management program, or if you are a dieter, connect with a provider who can get you started on your weight loss journey today. Need more inspiration? Listen to some success stories of dieters who have lost more than 200 pounds by starting a medically supervised program.


Source:
ScienceDaily


Blog written by Vanessa Ramalho/Robard Corporation


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5 Tips to Avoid the Ups and Downs of Yo-Yo Dieting



Yo-Yos go up and down… but your weight isn’t supposed to! Nonetheless, many dieters find themselves in an endless cycle of losing a portion of pounds, only to gain it back all over again — and then some. When you get stuck in what seems like an endless cycle of weight loss and regain, losing weight can become a frustrating and unachievable pursuit. How do you keep up the motivation to lose weight when you can’t seem to keep it off?

Don’t feel alone. Most dieters will experience weight regain at some point, and it is definitely frustrating. "People go on diets over and over again - and keep failing," says professor Eran Segal of the Weizmann Institute of Science in Israel. "It's a very common problem. Up to 50 percent of obese people suffer this relapsing pattern.” Such a pattern can lead to a lot of mental and emotional anguish, making dieters more likely to give up on their dreams of achieving a healthy weight.

But in addition to being emotionally and mentally draining, Yo-Yo dieting can actually come with health risks. Due to an increase in the stress hormone cortisol, consistently losing and gaining weight can increase your risk of developing heart disease, cancer and diabetes. Naturopathic doctor Natasha Turner claims that Yo-Yo dieting can also damage arteries and cause an increase in LDL cholesterol — both of which increase the risk of heart disease. And, there are many other health risks associated with being overweight and/or obese.

Additionally, Yo-Yo dieting is often associated with rapid weight loss in a short amount of time by limiting calorie intake. When you are undergoing low calorie diets without the supervision of a doctor or dietician, you can actually be depriving yourself of important nutrients and healthy calories. This type of dieting can slow your metabolism, lead to low energy levels, tiredness, fatigue and irritability. Not fun!

Step one of losing weight healthily and keeping it off in the long-term is to find support. Working with a weight loss professional who can provide you with proven tools and resources can be a far greater investment than any fad diet out there. Also consider these additional tips on how to avoid the endless cycle of Yo-Yo dieting:

Be realistic: A weight loss professional can help you set achievable goals. Make sure your goals come with a realistic time frame and can fit reasonably into your life, and that are aligned with health objectives. Having a goal to lose 20 pounds for a wedding two months from now can set you up for failure, and promote unhealthy habits. As a starting point, commit to goals that can be achieved with moderate effort.

Reward yourself: But not with food. When you reach a weight milestone, treat yourself to a massage. Or start a change jar and add the equivalent of what you would spend on junk food. At the end of every month, use the money accumulated to go on a shopping spree.

Identify your motivation: Motivation is key to success. “That is the number one most important thing,” says Judy Caplan, a registered dietitian and spokeswoman for the American Dietetic Association. List out why you want to get healthy, and refer to those reasons during moments of weakness.

Don’t give up: “One of the most important tips for being a successful weight loser is not to let past failed attempts keep you from trying again,” says Michael Dansinger, M.D., weight loss and nutrition advisor for “The Biggest Loser” and assistant professor at Tufts School of Medicine in Boston. “Every time you fail, you get more insight about what to do differently next time.”

Sources: Livestrong, U.S. News


Blog written by Vanessa Ramalho/Robard Corporation

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