1. Primary Care & Obesity Appathurai Balamurugan, MD, MPH Medical Director/Associate Director for Science Chronic Disease Branch/Center for Health Advancement Arkansas Department of Health & Assistant Professor Dept of Family and Preventive Medicine/ Dept of Epidemiology UAMS College of Medicine & Public Health

2. Her Story 38 year old African American Female patient of UAMS Family Medical Center clinic came to UAMS ED with chest pain since early this morning. Pain – retrosternal, 5/10, non radiating, exertional, slightly relieved with rest and aspirin, associated with some perspiration, lasted over 30 minutes. Vitals stable except for her BP 150/96.38 year old African American Female patient of UAMS Family Medical Center clinic came to UAMS ED with chest pain since early this morning. Pain – retrosternal, 5/10, non radiating, exertional, slightly relieved with rest and aspirin, associated with some perspiration, lasted over 30 minutes. Vitals stable except for her BP 150/96. Past Medical History – Obesity with BMI of 58, Hypertension, Obstructive sleep apnea, GERDPast Medical History – Obesity with BMI of 58, Hypertension, Obstructive sleep apnea, GERD Social History – divorced, single mother of 2 children, lives in College Station, Arkansas. She has 20 pack-years smoking history.Social History – divorced, single mother of 2 children, lives in College Station, Arkansas. She has 20 pack-years smoking history.

3. Her Story contd. After the patient was initially stabilized (MONA therapy), EKG did not show any ischemic changes or any other abnormal findings. Her LDL 260, HDL 38. Patient was admitted under observation under Family Medicine service.After the patient was initially stabilized (MONA therapy), EKG did not show any ischemic changes or any other abnormal findings. Her LDL 260, HDL 38. Patient was admitted under observation under Family Medicine service. Note: This is patient’s 5 th admission for similar complaint this year!Note: This is patient’s 5 th admission for similar complaint this year! Previously, patient was worked up for cardiac and non cardiac causes of her chest pain. Due to patient’s body habitus, she was unable to perform treadmill stress test hence had a dobutamine stress ECHO (DSE).Previously, patient was worked up for cardiac and non cardiac causes of her chest pain. Due to patient’s body habitus, she was unable to perform treadmill stress test hence had a dobutamine stress ECHO (DSE). DSE did not reveal any ischemic changes; however the imaging results were inconclusive due to her body habitus.DSE did not reveal any ischemic changes; however the imaging results were inconclusive due to her body habitus.

4. Her Story contd. Patient also had a persantine scan (nuclear study) to evaluate her heart, which did not show any ischemic changes; however the study was limited due to her body habitus.Patient also had a persantine scan (nuclear study) to evaluate her heart, which did not show any ischemic changes; however the study was limited due to her body habitus. The in-patient team subsequently consulted cardiology who suggested a cath to evaluate her coronary arteries in view of her high risk profile (Framingham risk score – 15%) and the high probability for a coronary event.The in-patient team subsequently consulted cardiology who suggested a cath to evaluate her coronary arteries in view of her high risk profile (Framingham risk score – 15%) and the high probability for a coronary event. The cath was clean, and patient was subsequently discharged. The chest pain was deemed as non cardiac in origin. Patient was counseled on hypertension and GERD management, diet, weight reduction and physical activity.The cath was clean, and patient was subsequently discharged. The chest pain was deemed as non cardiac in origin. Patient was counseled on hypertension and GERD management, diet, weight reduction and physical activity.

5. Primary Care & Obesity Obesity poses some unique decision making challenges to primary care.Obesity poses some unique decision making challenges to primary care. Can our health care system sustain the costs associated with obesity?Can our health care system sustain the costs associated with obesity? The importance of diet and physical activity counseling cannot be understated.The importance of diet and physical activity counseling cannot be understated.