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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.
1

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.



Tags: Diabetes, For Providers, Obesity, Treating Obesity, For Dieters

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