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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 – – – – – – 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