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PATIENT CARE PROCESS

Patient Care Process for the Management of Obesity

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Collect

  • Patient characteristics (e.g., age, race, sex)

  • Patient history (past medical, family, social—dietary habits, tobacco use)

  • Obesity-related conditions (see Figure 144-1)

  • Current medications including prescription, nonprescription, and herbal product use

  • Weight loss history and prior attempts to lose weight

  • Objective data

    • Height, weight, BMI, waist circumference, and blood pressure

    • Labs (e.g., glucose, hemoglobin A1c, lipid panel)

Assess

  • Presence of secondary obesity (e.g., hypothyroidism, Cushing syndrome)

  • Current medications that may contribute to weight gain (see Etiology)

  • Presence of obesity-related comorbidities (e.g., hypertension, dyslipidemia, coronary artery disease, type 2 diabetes mellitus, sleep apnea, increased waist circumference; see Figure 144-3)

  • Class of overweight and obesity determined by BMI, waist circumference, and obesity-related comorbidities (see Table 144-3)

  • Readiness to engage in weight loss efforts and potential barriers to success

  • Candidacy for treatment with implantable medical devices, bariatric surgery, or pharmacotherapy

Plan*

  • Nonpharmacologic lifestyle intervention including low-calorie diet, physical activity, and behavioral modifications

  • Pharmacotherapy (if appropriate) including specific medication, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 144-4)

  • Initial weight loss goal of 5% to 10% over a 6-month time period

  • Monitoring parameters including efficacy (weight loss) and tolerability (medication-specific adverse effects)

  • Patient education (e.g., purpose of dietary and lifestyle modification, drug therapy)

  • Self-monitoring of weight—when and how to record results

  • Referrals to other providers when appropriate (e.g., physician, dietician, psychologist)

Implement*

  • Educate patient regarding health risks associated with overweight and obesity

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up (e.g., monthly for first 3 months and every 3 months thereafter)

Follow-up: Monitor and Evaluate

  • Determine weight loss goal attainment

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 58. Obesity.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Two clinical measures of excess body fat, regardless of sex, are the body mass index (BMI) and the waist circumference (WC). BMI and WC provide a better assessment of total body fat than weight alone and are independent predictors of obesity-related disease risk.

  • Image not available. Excessive central adiposity increases risk for development of type 2 diabetes, hypertension, and dyslipidemia.

  • Image not available. Weight loss of as little as 5% of total body weight can significantly improve blood pressure, lipid levels, and glucose tolerance in overweight and obese patients. Sustained, large weight losses (eg, after bariatric surgery) are associated with a lower risk of cardiovascular events and death and with long-term improvements in many of the complications associated with obesity.

  • Image not available. Clinicians should consider the weight-altering effects of medications used to treat comorbid conditions (eg, antidepressants, antipsychotics, antiepileptics, and antidiabetics) and select medications that promote weight loss or ...

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