Nonsurgical Treatment Options
It is important to understand and address the unique needs of your severely obese patients. Many of these patients have been ridiculed about their weight by peers and even by physicians. When consulting with severely obese patients, it can be helpful to remember the following:
- Appreciate the impact weight bias has on patients. Obesity is a chronic medical condition, and placing the blame on the patient for their condition may be counterproductive
- Be an empathetic counselor. Showing empathy will help patients feel understood, which opens the door to having a therapeutic relationship
- Work to establish a patient-physician partnership if one does not already exist. Encouraging patients to be active participants in care can go a long way in addressing their health problems. Patients will be more compliant if they feel they have a say in their care and treatment decisions
- Approach the topic of weight with sensitivity. When discussing weight with patients use the term "overweight" instead of the words "fat" or "obese." Though it may be a difficult conversation to begin, if handled with sensitivity, it can be productive
- Be sure that your office environment is appropriate for everyone, including severely obese patients. Click here for a list of tips to ensure that a patient feels comfortable in your office environment
Before considering surgery, severely obese patients should be encouraged to try to lose weight through diet, exercise, pharmacotherapy, and behavior modification. While diet and behavior modification can be effective in the short term, many patients eventually relapse and regain weight over time.104 No published studies have demonstrated high rates of significant and sustained weight loss in severely obese patients through diet therapy, exercise, or behavioral modification.5 Weight loss surgery with appropriate follow-up is the only intervention that has shown successful long-term efficacy.69
If your patients have tried and failed to lose weight with diet and behavior modification, bariatric surgery may be an appropriate option. It is important to know when to refer a patient for a bariatric surgical consultation:
- For patients with a BMI of at least 40 kg/m2 or 35 kg/m2 with one or more severe comorbid conditions, bariatric surgery has been shown to be more effective than nonsurgical treatment for weight loss and control of comorbid conditions5
- The American Academy for Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic & Bariatric Surgery (ASMBS) have come together to recommend that bariatric surgery should be offered to severely obese patients8
- The American Diabetes Association (ADA) stated that bariatric surgery should be considered for adults with BMI 35 kg/m2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy42
Additional patient factors should be considered when referring a patient for surgical consultation:
- Demonstrated ability to comply with follow-up appointments, taking medications and completing required laboratory testing
- Motivated and interested in changing diet and lifestyle
- Realistic expectations about the surgery, including the risks and benefits
- Good support system
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