Obesity Practice Considerations

1. Obesity Practice Considerations

2. 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

3. 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

4. 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

5. 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

6. The Office Environment Example of Waiting Room

7. 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

8. 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.

9. 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

10. The Office Environment Protocols • Patient care treatment protocols for: • Treatment problems • Side effects • Complications • Medication use • Exercise program

11. 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

12. Treatment Process • Diagnosing the problem • Foods • Moods • Behaviors • Emotional eating patterns • Anxiety • Depression • Nocturnal binge eating

13. 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

14. 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

15. 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