1. Obesity Practice Considerations

2. 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

3. 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

4. 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

5. The Office 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 Physical Environment

6. The Office Environment Example of Waiting Room

7. The Office Environment 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 Equipment

8. 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 Materials

9. 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 Tools

10. Patient care treatment protocols for: –Treatment problems –Side effects –Complications –Medication use –Exercise program The Office Environment Protocols

11. 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

12. Treatment Process Diagnosing the problem –Foods –Moods –Behaviors –Emotional eating patterns –Anxiety –Depression –Nocturnal binge eating

13. 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

14. 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

15. 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