Office Management of the Obese Patient
Patient BMI
Obesity Management in an Outpatient Office Practice
37
29
33
21
40
31
27
20
Appropriate Office Environment for Obese Patients
Waiting room chairs without arms
Step stools next to examination tables
Large gowns and blood pressure cuffs
Scale that can weigh extremely obese patients, located in a private area
Appropriate obesity educational materials, handouts, and treatment protocols
Empathetic, respectful, and supportive office staff
Initial Office Visit
Include evaluation of potential obesity related diseases within history, physical examination, and laboratory tests
Obtain weight history, eating, and activity behaviors
Search for triggering factors, including medications
Measure weight, height, and calculate body mass index
Categorize obesity classification and health risk
Determine readiness to lose weight
Initiate treatment plan (involve other professionals if needed)
Discuss goals and expectations
Arrange follow-up and support
Kushner and Weinsier. Med Clin North Am 2000;84:387.
Selected Medications That Can Cause Weight Gain
Psychotropic medications
Tricyclic antidepressants
Monoamine oxidase inhibitors
Specific SSRIs
Atypical antipsychotics
Lithium
Specific anticonvulsants
?-adrenergic receptor blockers
SSRI=selective serotonin reuptake inhibitor
Diabetes medications
Insulin
Sulfonylureas
Thiazolidinediones
Highly active antiretroviral therapy
Tamoxifen
Steroid hormones
Glucocorticoids
Progestational steroids
Assessing Weight Loss Readiness
Motivation:
Stress level:
Psychiatric issues:
Time availability:
Patient seeks weight reduction
Free of major life crises
Free of severe depression, substance abuse, bulimia nervosa
Patient can devote 15-30 min/d to weight control for next 26 weeks
Patient Ready?
Prevent weight gain and explore barriers to weight reduction
Initiate weight loss therapy
YES
NO
Obese Patients Have Unrealistic Weight Loss Goals
Foster et al. J Consult Clin Psychol 1997;65:79.
Conclusions
Obesity is a chronic disease
Modest weight loss (5% -10% of body weight) can have considerable medical benefits
Lifestyle change (diet and physical activity) is the cornerstone of therapy
Pharmacotherapy can be useful in properly selected patients
Bariatric surgery is the most effective therapy for obesity
Obesity-Related Resources Professional Associations
North American Association for the Study of Obesity (NAASO)
American Academy of Family Physicians (AAFP)
American College of Sports Medicine (ACSM)
American Diabetes Association (ADA)
American Dietetic Association (ADA)
American Gastroenterological Association (AGA)
American Heart Association (AOA)
American Obesity Association (AOA)
American Society for Bariatric Surgery (ASBS)
www.naaso.org
www.aafp.org
www.acsm.org
www.diabetes.org
www.eatright.org
www.gastro.org
www.americanheart.org
www.obesity.org
www.asbs.org
Centers for Disease Control (CDC): Obesity and Overweight
Centers for Disease Control (CDC): Prevalence data and growth charts
National Institutes of Health (NIH)
National Institutes of Diabetes & Digestive & Kidney Diseases (NIDDK) Weight-Control Information Network (WIN)
National Institutes of Diabetes & Digestive & Kidney Diseases (NIDDK) Weight Loss and Control
National Library of Medicine, MEDLINE Plus
Obesity-Related Resources Government Organizations
www.cdc.gov/nccdphp/dnpa/obesity/ index.htm
www.cdc.gov/nchs/nhanes.htm
www.nih.gov
www.niddk.nih.gov/health/nutrit/win.htm
www.niddk.nih.gov/health/nutrit/nutrit. htm
www.nlm.nih.gov/medlineplus/obesity. html