Transcript WHAT IS BARIATRIC MEDICINE?

AMERICAN SOCIETY OF BARIATRIC PHYSCIANS
Established 1950
BARIATRIC MEDICINE
 THE MEDICAL TREATMENT OF OBESITY
AND ITS RELATED CONDITIONS.
 The term bariatric is derived from the Greek
word barros, meaning heavy.
BARIATRIC PHYSICIANS
 …help patients reduce body fat using an
individualized approach crafted for the
patient.
 Bariatricians belonging to the American
Society of Bariatric Physicians (ASBP) are
encouraged to adhere to its Bariatric Practice
Guidelines for medical (non-surgical) body
fat reduction/weight loss.
THE AMERICAN SOCIETY
OF BARIATRIC PHYSICIANS (ASBP)
 A professional association for physicians, nurse
practitioners and physicians assistants who treat
patients who are overweight or obese.
 The primary source for clinical education and training
for non-surgical medical management of obesity.
 A collaborative organization that provides its members
practical information and business tools to implement
a successful medical bariatric practice.
BARIATRIC PRACTICE GUIDELINES
1. Perform an initial patient work up.
2. Provide counseling and follow-up.
3. Review the potential benefits and risks of any
medications that may be used during treatment.
4. Develop an individual weight maintenance
program.
INITIAL PATIENT WORK UP
 Complete physical and history.
 Laboratory workup to identify metabolic
problems and tailor treatment.
 ECG if appropriate.
 Body composition analysis.
 Discussion of patient desired weight loss.
 Review of current eating habits.
 Review of activity level.
INITIAL PATIENT WORK UP
 The bariatric history and physical has
unique aspects that enable the bariatrician
to:
 identify underlying co-morbidities
 determine appropriate risk stratification
 develop individualized treatment plans that
optimize the patient’s likelihood of success
COUNSELING
 Counseling may include:
 Dietary modifications
 Appropriate eating habits
 Behavior modifications
 Psychological support
 Referral for family counseling
DIETARY MODIFICATIONS
 Ketogenic diet
 Meal supplements
 Low fat
 Low carbohydrate
 Adequate protein
MEDICATIONS
 TYPES OF AGENTS
 NORADRENERGIC
↓ HUNGER/APPETITE
 SEROTONERGIC
↑ SATIETY
 ENZYME INHIBITORS
↓ ABSORPTION
CALORIES
NUTRIENTS
ANORECTIC DRUGS
 NOREPINEPHRINE
 PHENTERMINE
 DIETHYLPROPION
 PHENDIMETRAZINE
 NOREPINEPHRINE & SEROTONIN
 SIBUTRAMINE
Number of patients reporting drug-related
side effects
Phentermine
(n = 30)
14
Placebo
(n = 29)
13
Nervous
4
2
Insomnia
4
3
Dizzy
2
0
Sweating
2
2
Irritability
0
2
Headaches
MEDICATION RISKS
 Potential side effects
 Cautions/contraindications
 Dosing considerations
INDIVIDUALIZED PROGRAM
 Initial patient work up drives individualized program
 Metabolic indicators impact type of dietary
modification
 Past history and current weight drive exercise
prescription
 Social and psychological patient report determines
counseling and/or psych referral needs.
FOLLOW UP
 Frequently scheduled office visits during weight loss
phase.
 Regularly scheduled laboratory testing at key intervals
to determine metabolic changes.
 Individualized plans developed for maintaining weight
loss.
 Individualized recovery plans developed if any weight
gain occurs.
QUESTIONS?
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