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WHAT IS OBESITY MEDICINE?
CLASS II OBESITY CLASS III OBESITYNORMAL WEIGHT OVERWEIGHT CLASS I OBESITYClassification (kg/m2):
18.5-24.9 25.0-29.9 30.0-34.9 35.0-39.9
HOW DO YOU MEASURE OBESITY?
CHRONIC WEIGHT MANAGEMENT REDUCES
THE COST OF LIVING BY REDUCING: 10, 11, 12 CHRONIC WEIGHT MANAGEMENT ALSO REDUCES
DISEASE RISK 13
MEDICATIONS CO-PAYS
FOOD COSTS ACCIDENT PRONENESS
RISK FOR CANCER & OTHER CHRONIC
DISEASES
HOSPITALIZATIONS
MEDICAL VISITS
TIME OFF WORK AND LOST WAGES
Potential impact of 5% average BMI reduction in the U.S. by 2020:
Million hypertension cases avoided3.5 Million cancer
cases avoided0.3
Million heart disease and stroke cases avoided2.9
Million diabetes cases avoided3.6 Million arthritis
cases avoided1.9
BODY MASS INDEX 1, 2 ,3
WHAT DOES COMPREHENSIVE MEDICAL OBESITY TREATMENT INCLUDE?
Behavior MedicationPhysical ActivityNutrition
OBESITY MEDICINE: THE FIELD OF MEDICINE DEDICATED TO THE COMPREHENSIVE CARE OF PATIENTS WITH OBESITY
References: 1 De Lorenzo A, Soldati L, Sarlo F, Calvani M, Di Lorenzo N, Di Renzo L: New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol 2016 22:681-703; 2 Rahman M, Berenson AB: Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol 2010 115:982-988; 3 Misra A, Shrivastava U: Obesity and dyslipidemia in South Asians. Nutrients 2013 5:2708-2733; 4 American Council on Exercise: What are the guidelines for percentage of body fat loss? http://www.acefitness.org/acefit/healthy-living-article/60/112/what-are-the-guidelines-for-percentage-of-body-fat (Accessed August 20, 2016). 2009; 5 Jacobson TA IM, Maki KC, Orringer CE, Bays HE, Jones PH, McKenney JM, Grundy SM, Gill EA, Wild RA, Wilson DP, Brown WV: National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 - executive summary. J Clin Lipidol 2014 8:473-488; 6 Bays H: Central obesity as a clinical marker of adiposopathy; increased visceral adiposity as a surrogate marker for global fat dysfunction. Curr Opin Endocrinol Diabetes Obes 2014 21:345-351; 7 Carroll JF, Chiapa AL, Rodriquez M, Phelps DR, Cardarelli KM, Vishwanatha JK, Bae S, Cardarelli R: Visceral fat, waist circumference, and BMI: impact of race/ethnicity. Obesity 2008 16:600-607; 8 Wang Z, Ma J, Si D: Optimal cut-off values and population means of waist circumference in different populations. Nutr Res Rev 2010 23:191-199; 9 Sharma AM, Kushner RF: Int J Obes 2009;33:289-95; 10 Health Management Research Center, University of Michigan, 2001; 11 U.S. Bureau of Labor Statistics, Consumer Expenditures in 2006; 12 Colditz, GA: Economic costs of obesity and inactivity. Med Science Sports Exercise 1999; 13 Levi et al: F as in fat: how obesity threatens America’s future. 2012. 14 Waters H, DeVol R: Weighing down America: The health and economic impact of obesity. Milken Institute 2016.
>40
LOOKING BEYOND BMI:
ACCEPTABLE OBESITYClassification: Classification:ESSENTIAL FAT ATHLETES FITNESS
2-5% 6-13% 14-17% 18-24% >25%
>32%10-13% 14-20% 21-24% 25-31%
PERCENT BODY FAT 4 WAIST CIRCUMFERENCE 5, 6, 7, 8
ABDOMINAL OBESITY
>40inches
>102centimeters
STAGE 0 STAGE 1 STAGE 2 STAGE 3 STAGE 4
The Edmonton Obesity Staging System applies a staging system of the medical, mental, and possible functional limitations a patient with obesity may experience, helping clinicians assess risk for that individual and evaluate how their weight affects their health.
No obesity-related risk factors
Pre-clinical risk factors: borderline HTN or DM, minor aches, or psychopathology
Established obesity-related disease: HTN, DM, PCOS, moderate limitations of ADL
Established organ damage: MI, CHF, DM comp, significant limitations of ADL
Severe disabilities: end stage and limitations (e.g., wheelchair use)
EDMONTON OBESITY STAGING SYSTEM 9
>35inches
>88centimeters
%
Clinical Pearls What Is Obesity Medicine?
1) Obesity medicine is the field of medicine dedicated to the comprehensive care of patients with obesity.
2) Obesity medicine clinicians often use measurements other than BMI to diagnose obesity.
3) The comprehensive clinical approach to obesity treatment involves nutrition, physical activity, behavior, and medication.
4) Even modest (5%) weight loss is clinically meaningful and reduces the cost of living for patients with obesity.
5) In 2014, the direct and indirect costs associated with treating obesity and obesity-related conditions totaled $1.42 trillion.14
6) Comprehensive obesity treatment may include intermediary procedures or surgical intervention.
What Is Obesity Medicine?
Behavior MedicationAssessment and Evaluation
Chronic Disease of
Obesity
Physical ActivityNutrition
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals. Learn more at www.obesitymedicine.org.
Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
About the Obesity Treatment Foundation
The Obesity Treatment Foundation is a 501(c)(3) charitable organization developed to elevate awareness among health care providers that obesity is a chronic disease and to amplify the quality and quantity of clinician-driven, practice-based obesity treatment research. Learn more at www.obesitytreatmentfoundation.org.
101 University Blvd. Ste. 330 | Denver, CO 80206 | p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org
ELEVATEDBLOOD
PRESSURE
DYSLIPIDEMIA
ELEVATED GLUCOSE
CENTRAL ADIPOSITY
Obesity is a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.
The Definition of Obesity
Obesity Is a Multi-factorial
Disease
Health Consequences of Obesity
Metabolic Syndrome Is a Complex Condition
Impact of Insulin Resistance1
INSULIN RESISTANCE
Impaired Glycemia
Retinopathy, Nephropathy, Neuropathy
Microvascular DiseaseStroke, Coronary Heart Disease
Macrovascular Disease
Metabolic Syndrome
Type 2 Diabetes
Early Cardiovascular Disease
Dyslipidemia
Obesity Hypertension
DiseaseSystem
Cardiovascular
Endocrine
Pulmonary
Gastrointestinal
Neurologic
Renal
Musculoskeletal
Oncology
Hematology
Integument
Psycho-social
Myocardial Infarction • Stroke •Peripheral Vascular Disease • Hypertension • Congestive Heart Failure and Cor Pulmonale • Hypertension • Thromboembolic Events • Varicose Veins
Type 2 Diabetes • Gout • Polycystic Ovary Syndrome • Infertility
Dyspnea • Obstructive Sleep Apnea • Hypoventilation Syndrome • Pickwickian Syndrome • Asthma
Nonalcoholic Fatty Liver Disease • Cholelithiasis • GERD • Hernias
Intracranial Hypertension • Stroke • Nerve Entrapment
Nephrolithiasis • Glomerulopathy • Renal Cancer
Osteoarthritis (Knees, Hips) • Immobility • Low Back Pain • Myalgia • Impaired Balance • Gait Disturbance
Breast Cancer • Endometrial Cancer • Esophageal Cancer • Colon Cancer • Pancreatic Cancer
Prothrombic State • Multiple Myeloma
Stasis Pigmentation • Venous Stasis Ulcers • Cellulitis • Skin Tags • Intertrigo • Carbuncles
Depression • Low Self-esteem • Hopelessness • Body-image Dissatisfaction • Diminished Sex Drive • Impaired Intimacy and Sexual Relationships
COMMON COMPONENTS OF METABOLIC SYNDROME
All content, unless otherwise noted, is adapted from the Obesity Algorithm®. 1. ACCORD STUDY, ADVANCE STUDY JAMA. 2008;300(17):2051-2053
MEDICAL
NEUROBEHAVIO
RAL
IMM
UN
E
GENETIC / EPIGEN
ETIC
EN
DO
CR
INE
EN
VIRONMENT
How Obesity Relates to Metabolic Syndrome and Insulin Resistance
Metabolic consequences of obesity include the components of metabolic syndrome plus proinflammatory and prothrombic states.
Type 2 diabetes is closely associated with obesity and begins with insulin resistance that starts 10 to 15 years prior to diagnosis.
CHRONIC DISEASE OF OBESITY
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
BehaviorAssessment and Evaluation
Physical ActivityNutrition Medication
Clinical Pearls Chronic Disease of Obesity
1) The negative health impacts of obesity can be broadly characterized as metabolic, biomechanical, or psychological.
2) Hunger and satiety are regulated extensively by a complex system of hormones released by the gastrointestinal system, adipose tissue, and brain.
3) Obesity is strongly associated with multiple cancers, including esophageal, endometrial, and breast cancer.
Chronic Disease of Obesity
What Is Obesity Medicine?
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals.
Contact Us
101 University Blvd. Ste. 330 | Denver, CO 80206 p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org www.obesitymedicine.org
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
OF OBESITY MANAGEMENT
AVOID DEROGATORY LANGUAGE
INSTEAD OFUSE
Overweight
Unhealthy Weight
Heavy
Eating Habits
Physical Activity
Fat
Obese
Morbidly Obese
Diet
Exercise
5 A’S
y For permission to discuss body weight
y About readiness for change
ASK
y About health benefits of modest weight loss (5-10%)
y About long-term strategy and treatment options
ADVISE
y Identify and address barriers
y Provide resources
y Schedule regular follow-up
ARRANGE/ASSIST
y BMI, waist circumference, obesity stage
y Drivers and complications of excess weight
ASSESS
y On realistic expectations, targets, and behavioral changes
AGREE
PATIENT HISTORY
Weight Gain Medical
Previous Weight Loss Eating Disorders
Nutrition
Family
Social
Physical Activity
Age of onset Highest/lowest weight Rate of weight gain Inciting factors/major
life events
Past/current medical problems
Surgical history Allergies Current medications
What’s been tried What worked What didn’t work Motivators
Prior diagnosis Medical treatment(s)
Eating patterns Triggers Reasons for eating out Household factors
Obesity Metabolic diseases Psychiatric disorders
Readiness Motivators Education Occupation Family/household Sleeping behavior Major life stresses/events Tobacco/alcohol/cannabis
/other drug use
Current level of activity Favorite activities Activities able
to maintain Barriers
1 2
3
45
PERFORM A PHYSICAL EXAMINATION
BLOOD PRESSURE
WAISTCIRCUMFERENCE
NECKCIRCUMFERENCE
1. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y: Clinical review: Modified 5 As: Minimal intervention for obesity counseling in primary care. Can Fam Physician 2013 59:27-31.
RESPIRATORYRATE
EKG
ALSO EXAMINE:- Resting Metabolic Rate- Body Mass Index- Body Composition
1
ASSESSMENT AND EVALUATIONA COMPONENT OF CLINICAL OBESITY TREATMENT
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
MedicationBehaviorChronic Disease of
Obesity
Physical ActivityNutrition Medication
Clinical Pearls
1) Obtain the patient’s current weight and a thorough weight history during the initial evaluation.
2) Obesity can be defined by an elevated BMI, body fat percentage, waist circumference, and other metabolic factors. Bioelectric impedance is the most commonly used method of measuring body fat percentage.
3) During the physical examination, acanthosis nigricans is a sign of insulin resistance.
4) Laboratory tests and EKG are an important part of the evaluation to diagnose diseases related to obesity.
5) The initial assessment should determine if the patient has other medical problems related to obesity. These co-morbidities need to be monitored as well.
Assessment and Evaluation
Assessment and Evaluation
What Is Obesity Medicine?
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals.
Contact Us
101 University Blvd. Ste. 330 | Denver, CO 80206 p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org www.obesitymedicine.org
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
DIETARY FACTORS TO CONSIDER
CONSIDER THE PATIENT’S:
COMMON NUTRITIONAL APPROACHES
Low-carbohydrate Diet
Mediterranean Diet
Low-fat Diet
<45% of calories from carbohydrates
Ketogenic (< 50 g carbohydrates)
35-40% fat
Fish, nuts, healthy fats, fruits, vegetables, whole grains, legumes, dairy
<20% fat, 55-65% carbs, ~15% protein
<10% saturated fat
triglycerides, HDL cholesterol
cardiovascular mortality, type 2 diabetes
total cholesterol, LDL cholesterol
Characteristics
Characteristics
Health Benefits
Health Benefits
Health Benefits
Health Benefits
Characteristics
DASH Diet
Dietary approaches to stop hypertension
Not intended for weight loss unless caloric intake is restricted
blood pressure
Health Benefits
Characteristics
Meal Replacements
Pre-packaged foods
Isocaloric energy-restricted meal replacements
Can be used with any dietary approach
Greater weight loss with 2 meal replacements per day compared to less frequent use.1
1. Tsai AG, Wadden TA. Obesity 2006;14(8):1283-1293.
Regardless of macronutrient composition, all diets should include physician education and patient monitoring to maintain safety and achieve the optimal long-term effects.
Personal preferences Ethnic or religious requirements Allergies and food intolerances Comorbidities: Hypertension, type 2 diabetes,
dyslipidemia, gout, recurrent kidney stones, liver or kidney disease
Nutritional needs
There are many different dietary options that work, but the right one to use will depend on the individual patient.
Vegetarian Diet
Exclusion of all or most animal proteins
Protein sources: Low-fat dairy, soy, legumes, whole grains, nuts, seeds
LDL cholesterol, cardiovascular mortality, type 2 diabetes
Characteristics Characteristics
Health Benefits
NUTRITIONA COMPONENT OF CLINICAL OBESITY TREATMENT
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Clinical Pearls
1) The diet that works is the one the patient can stick with and incorporate into their lifestyle long-term.
2) Think beyond calories – current evidence suggests that not all calories are created equal.
3) Saturated fats and unsaturated fats provide a source of energy, but like calories, not all fats are created equal.
4) Meal replacement strategies can be very effective for weight loss and weight maintenance.
Nutrition
Nutrition
What Is Obesity Medicine?
BehaviorPhysical ActivityAssessment and Evaluation
MedicationChronic Disease of
Obesity
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals.
Contact Us
101 University Blvd. Ste. 330 | Denver, CO 80206 p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org www.obesitymedicine.org
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
*Donnelly J. Am College Sports Med. 2009.**U.S. Health and Human Services. 2008.
— Moderate aerobic exercise 150 min/week + strength training at least 2x/week
— 150-250 minutes per week*— 150-300 minutes per week**
— 200-300 minutes per week*— 300-420 minutes per week**
HEALTH BENEFITS:
Cardiovascular functionBlood glucose regulation
DyslipidemiaIndependenceSocialization
Sexual functionHDL cholesterol
IMPROVES Blood pressure
Risk of certain cancersMortality rateMedications
Dementia riskPain
Depression
REDUCES
Non-Exercise Activity Thermogenesis (NEAT)
NOT ALL PHYSICALACTIVITY IS EXERCISE
Common daily activities, such as walking, standing, and climbing stairs, can result in up to 2,000 kcal of energy expenditure per day.
CORECOMPONENTSOF AN EXERCISEPRESCRIPTION
FREQUENCY
INTENSITY
TIME
TYPE
ENJOYMENT
GENERAL HEALTH BENEFIT
PREVENTION OF WEIGHT GAIN
PREVENTION OF WEIGHT REGAIN
HOW MUCH PHYSICAL ACTIVITY IS ENOUGH?
GETTING STARTED
Low or no-impact activities
Balance training
Strength training
START
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
PHYSICAL ACTIVITYA COMPONENT OF CLINICAL OBESITY TREATMENT
Assessment and Evaluation
BehaviorChronic Disease of
Obesity
Nutrition Medication
Physical Activity
What Is Obesity Medicine?
1) Know the physical activity guidelines and share them with your patients. They can’t hit the mark if they don’t know the goal.
2) Set realistic expectations with your patients about physical activity and weight loss. While weight loss is difficult with physical activity alone, it is necessary for successful weight maintenance.
3) Work with your patients to determine the physical activities that meet their interests, needs, and abilities.
4) Identify appropriate resources to share with your patients, such as those available from the Obesity Action Coalition.
5) Have your patients self-track their progress and review it together at follow-up visits.
Physical ActivityClinical Pearls
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals.
Contact Us
101 University Blvd. Ste. 330 | Denver, CO 80206 p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org www.obesitymedicine.org
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
INTERPERSONAL THERAPY
COGNITIVE BEHAVIORAL THERAPY
MOTIVATIONAL INTERVIEWING
CORE SKILLS FOR
MOTIVATIONAL
INTERVIEWING
SPIRIT OF
MOTIVATIONAL
INTERVIEWING
Open questions
AffirmationsReflectionsSummaries
CompassionAcceptancePartnershipEvocation
OBESITY
Self-Monitoring
Social Support
StimulusControl
CognitiveRestructuring
ContingencyManagement
Problem-Solving
Stress Management
Wadden and Foster, Med Clin North Am 2000:84:441.
Resolution of conflicts
Adaptation for change
Focus on only one or two problem areas
Target deficits
STAGES OF CHANGE
Pre-contemplation: No intention to change / unaware of need to change
Action: Build self-awareness; discuss risks and benefits; explore ambivalence
Contemplation: Aware of a need to change / interested in changing within next six months
Action: Resolve ambivalence; explore pros and cons; assess knowledge
Preparation: Open to and willing to change within next 30 days
Action: Resolve ambivalence / get commitment
Action: Initiation of change / committing to goal
Action: Provide tailored self-help materials and encouragement for small changes
Maintenance: Continued change for longer than six months
Action: Continued positive reinforcement and periodic follow-up
1
2
3
4
5
BEHAVIORS OF SUCCESSFUL WEIGHT MAINTAINERS*
78% eat breakfast every day
62% watch less than 10 hours of TV per week
90% exercise, on average, about one hour per day
weigh themselves at least once per week75%
*National Weight Control Registry Data; Wyatt et al. Obes Res 2002 Feb;10(2):78-82; Butryn et al. Obesity 2007 Dec;15(12) 3019-6; Raynor et al. Obesity 2006 Oct;14(10); Phelan et al. Obesity 2006 Apr;14(4):710-6.
BEHAVIORAL THERAPY TECHNIQUES
BEHAVIORA COMPONENT OF CLINICAL OBESITY TREATMENT
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Nutrition Physical ActivityAssessment and Evaluation
MedicationChronic Disease of
ObesityBehavior
What Is Obesity Medicine?
Clinical Pearls
1) Behaviors are affected by brain neurotransmitters, specifically dopamine and serotonin, and are often beyond an individual’s willpower.
2) Recognizing that positive behavioral change can be achieved and maintained is integral to clinically significant weight management.
3) Motivational interviewing and collaborative goal-setting are effective tools in the primary care setting.
4) Understand your role as a clinician in helping patients with the stages of change, utilizing the 5 A’s of obesity management1, and implementing SMART (specific, measurable, achievable, relevant, time-based) goals.
5) Sleep disorders, disordered/dysfunctional eating, and carbohydrate cravings can influence and be influenced by behaviors.
Behavior
1. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y: Clinical review: Modified 5 As: Minimal intervention for obesity counseling in primary care. Can Fam Physician 2013 59:27-31.
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals.
Contact Us
101 University Blvd. Ste. 330 | Denver, CO 80206 p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org www.obesitymedicine.org
© Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission.
Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
Purposes: Mechanisms of Action:Anti-obesity medications alter physiology, not only behaviors.
� Treat the disease of obesity � Facilitate the management
of eating behavior � Slow the progression of weight
gain and regain � Improve the weight, health, and
quality of life of the patient
� Decrease hunger � Decrease appetite � Increase satiety � Decrease cravings
� Block fat absorption � Increase adherence by
mitigating biological or genetic factors
Anti-obesity medications are most effective as part of a comprehensive treatment plan that includes nutrition, physical activity, and behavior modification.
How Anti-obesity Medications Make a Difference
Medication Class Mechanisms of Action for Weight Loss
Sympathomimetic aminesPhentermine*, Phendimetrazine*, Diethylpropion*
Orlistat (Xenical®, alli®)
Lorcaserin (Belviq®)
Phentermine/ Topiramate ER (Qsymia®)
Naltrexone/Bupropion (Contrave®)
Liraglutide (Saxenda®)
Pancreatic lipase inhibitor
Serotonin 5HT2c agonist
Sympathomimetic amine + anti-epileptic
Stimulates POMC; naltrexone blocks beta endorphin-mediated suppression of alpha MSH
GLP-1 agonist
Decreases absorption of fat
Decreases appetite and food intake through release of catecholamines in hypothalamus
Decreases food intake and increases satiety through activation of POMC neurons in hypothalamus
Reduces appetite, decreases food consumption and satiety enhancement through release of catecholamines in the hypothalamus
Exerts effect on appetite regulatory center and the reward system to regulate appetite and reduce cravings
Increases satiety, decreases food intake and appetite via GLP-1 receptors in brain
The Anti-obesity Medications:
Manage Your Patients’ Expectations in Advance
DOCUMENT
PARTICIPATE
CONSULT
� Rationale: Initial drug prescription and prescription changes
� Every Visit: Vital signs, appearance, mood, beneficial and adverse effects
� Utilize the Obesity Medicine Association’s CME to keep up with trends and learn best prescribing practices
� Always review the PI � Be aware of the stoppage rules: 5% weight loss
at 12 weeks of full-dose therapy for phentermine, phendimetrazine, diethylpropion, orlistat, lorcaserin, phentermine/topiramate, and naltrexone/bupropion, and 4% weight loss at 12 weeks of full-dose therapy for liraglutide
Discuss anticipated results prior to treatment and set realistic goals.
� Weight loss is often slower than patients expect
� What a patient calls a plateau is often the expected treatment response
� Maintaining weight loss is difficult without an intervention plan
� Regular or intermittent medications may be necessary for long-term maintenance
� Obesity is a chronic disease requiring lifelong treatment
� Long-term favorable patient health outcomes are the primary goal of therapy
� 5-10% weight loss produces health benefits
Always check with your local and state medical/pharmacy boards before prescribing anti-obesity medications. Local and state laws and regulations may vary.
Good Practices When Prescribing Anti-obesity Medications
*FDA-approved only for short-term usage but frequently prescribed off-label for longer durations.
MEDICATIONA COMPONENT OF CLINICAL OBESITY TREATMENT
BehaviorAssessment and Evaluation
Chronic Disease of
Obesity
Physical ActivityNutrition
Clinical Pearls Medication
1) Medication is an evidenced-based tool to support the physiologic and behavioral changes necessary for sustained weight loss.
2) As with other chronic diseases, medications for the treatment of obesity should be used long-term.
3) Medications used to treat other chronic diseases may cause weight gain. It is important to identify these medications during the initial evaluation and switch the patient to a weight-negative medication if possible.
4) Individualizing treatment to meet the patient’s needs is important and should include a comprehensive treatment plan in addition to anti-obesity medication.
5) Individuals who have undergone bariatric surgery may also benefit from an anti-obesity medication post-surgically to control their disease, particularly if they experience weight regain.
Medication
What Is Obesity Medicine?
About the Obesity Medicine Association
The Obesity Medicine Association (OMA) is the largest organization of clinicians dedicated to preventing, treating, and reversing the disease of obesity. Members of OMA believe treating obesity requires a scientific and individualized approach comprised of nutrition, physical activity, behavior, and medication. When personalized, this comprehensive approach helps patients achieve their weight and health goals.
Contact Us
101 University Blvd. Ste. 330 | Denver, CO 80206 p 303.770.2526 | f 303.779.4834 | info@obesitymedicine.org www.obesitymedicine.org
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Continue Learning Online
Visit bit.ly/obesity-treatment to watch the Fundamentals of Obesity Treatment Course on demand through the Obesity Medicine Academy. This course, worth 4.5 CME/CE credit hours, provides a high-level overview of the six components of clinical obesity treatment and offers tips for implementing basic evaluation and treatment techniques in practice.
Want more? The Obesity Medicine Academy is the premier online learning platform for evidence-based, peer-reviewed education. The Academy’s library contains more than 200 hours of clinically focused education on the most effective approaches for treating obesity and obesity-related conditions. Continue learning now at www.OMAcademy.org.
Chronic Disease of Obesity
Assessment and Evaluation
Nutrition Physical Activity Behavior Medication
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