Transcript Practical Considerations in Starting an Obesity Practice

Obesity Practice Considerations
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
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
Obesity is a Medical Disease
to Be Treated by Professionals
Using Medical Tools
• Shared Decision Making Model
• Match the tools with the task, the treatment with
the patient
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Medical
Psychological
Diet
Cognitive-Behavioral
Physical Activity
Surgical
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
The Office Environment
Example of Waiting Room
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
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.
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
The Office Environment
Protocols
• Patient care treatment protocols for:
– Treatment problems
– Side effects
– Complications
– Medication use
– Exercise program
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
Treatment Process
• Diagnosing the problem
– Foods
– Moods
– Behaviors
– Emotional eating patterns
– Anxiety
– Depression
– Nocturnal binge eating
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
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
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