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.



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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


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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


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A 'Mental Diet' for Weight Management



Getting healthy and losing weight is not an easy endeavor — especially, if you are not following a mental diet. So much energy and focus tends to go into the physical components of weight management, but the mental aspects are just as vital. I would like to propose a “Mental Diet” to go along with the physical aspects of weight management.

For Breakfast
The morning can be a critical compass to direct your focus for the day. Even if you are not a “morning person” that is full of energy, it is important is to start your day off with intention. This means that you will set aside time for self-care before too many responsibilities or distractions consume your morning. The morning is actually the best time for exercise or meditation, even if it is for five minutes, as you will have less excuses/distractions and more “willpower” in the morning. As the day progresses, we deplete our “willpower tank” which tends to result in an inability to tackle difficult tasks in the evening. So, the ingredients for a good mental breakfast include: At least five minutes of exercise or meditation, self-focus, gain insight and perspective on the day and start the day after taking care of yourself first.

For Lunch
It is important that you schedule time to break for lunch. If you are the type of person that gets busy and easily distracted, you will want to set an alarm to remind yourself to take a break. We are such as fast-paced society that we may not pay attention to how much and how fast we are eating. It’s not uncommon for people to engage in “mindless” eating while sitting at their desk, in front of the TV or driving — suddenly you realize that the food is gone and you have not paid attention to satiety. Instead of just go through the motions of putting food in your mouth, focus on eating slowly and truly paying attention to each bite and monitoring how we feel. The ingredients for a healthy mental lunch include: 15-30 minutes to recharge by refueling with a calm, mindful meal or shake.

For Dinner
You need to have a moment to digest the day. It is important to recognize that “emotional eating” and cravings may increase toward the end of the day. Unfortunately, you may have used most of the energy from your “willpower tank” and begin to want sweets or snacks after dinner. After a long day, “rewarding” yourself with unhealthy foods may sound like the perfect way to unwind. However, indulging in unhealthy foods will only leave you craving more and potentially feeling guilt and remorse. Instead of trying to “eat” your emotions, talk it out or journal your thoughts and feelings. As you prepare for sleep, limit your time with “screens” such as TV, phones and computers and start to focus on relaxation. So the healthy mental dinner includes: Reduce the mental weight of the day by writing down three things that went well for the day and if there is anything that you might need to do for the following day.

Behavioral change and extensive patient education materials are interwoven into all of Robard’s weight loss programs. If you’re a medical provider and would like more information, click here.

Blog written by Devin Vicknair, Ph.D., LPC, Behavioral Health Coordinator at Gwinnett Medical Center: Center for Weight Management.

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You Can’t Afford to Ignore Obesity: How Obesity Treatment Saves Time, Money and Lives



Why should a busy healthcare provider take time out of their day to treat obesity when their patients are dealing with so many other health issues? This seems to be the prevailing question among many providers, despite obesity’s 2013 designation as a disease. There are so many other diseases and ailments that need to be treated, so why obesity?

The answer: Because we can’t afford not to! And that applies to time, money and the health of your patients.

It’s true that chronic diseases suck up the majority of healthcare resources; 75 percent of all health care costs are linked to chronic conditions. People with chronic conditions are the most frequent users of health care in the U.S., and they account for 81 percent of hospital admissions; 91 percent of all prescriptions filled; and 76 percent of all physician visits. Chronic disease is widespread, and it’s only getting worse. By 2025, chronic diseases will affect an estimated 164 million Americans — nearly half (49 percent) of the population

In response to the growing concern over chronic disease, many healthcare providers and hospitals are investing thousands of dollars in resources and time to implement multi-level treatment plans targeting chronic conditions. But the question many advocates are forgetting to ask is: What is one of the most common links between many chronic conditions?

The answer: OBESITY.

Obesity is associated with significantly increased risk of more than 20 chronic diseases and health conditions that cause devastating consequences and increased mortality. Consider the following statistics:

• In the often-cited Framingham Offspring Study, obesity was responsible for 78 percent of cases of hypertension in men and 64 percent in women
• The well-known Nurses’ Health Study of more than 44,000 women found high waist circumference resulted in a two-fold increase in coronary heart disease
More than 85 percent of people who have type 2 diabetes are overweight, and more than 50 percent are obese
• Overweight and obesity are associated with increased mortality from diabetes and kidney disease, resulting in over 60,000 excess deaths per year

And this is just the tip of the iceberg. Obesity, in many cases, is the direct cause of many of the chronic conditions that we are spending so much time and money treating. Many of these conditions can be prevented, delayed, or alleviated by simply treating the cause, not just the symptoms. Research shows that modest weight loss (five to 10 percent of body weight) can reduce the risk of developing chronic conditions dramatically, and this amount of weight loss is achievable through various evidence-based medical obesity treatment models.

Not only can obesity treatment save physicians time and money by decreasing healthcare costs associated with comorbid chronic conditions, it has also been shown to be a proven revenue generating model, with real financial benefits. In a climate when we’re unsure about where we will stand with insurance and Medicare, it is imperative for healthcare providers to proactively look for new and innovative models to save time and money, and ultimately, to save lives.

Are you still asking yourself, “Why treat obesity?”


Sources: Partnership to Fight Chronic Disease, Hospitals & Health Networks, Stop Obesity Alliance

Blog written by Vanessa Ramalho/Robard Corporation


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