Obesity Management in Primary CareMonday, August 11, 2008
Here is what I would consider the bare minimum of obesity management, easily doable in a busy family practice (even with virtually no obesity expertise):
1. DO NOT BLAME, THREATEN, OR PRESSURE YOUR PATIENT!
2. DO NOT SUGGEST OR ENCOURAGE RIDICULOUSLY UNREALISTIC WEIGHT-LOSS TARGETS! (for most patients 5-10% weight loss is realistic, but even that is incredibly hard to keep off).
3. DO educate your patient on the risks of overweight and obesity and that obesity once established is a chronic condition (any treatment that works is essentially lifelong!).
4. DO encourage your patient to eat regularly (especially breakfast!) and keep a food diary. (For most people, the key to not gaining weight is to not get hungry). For emotional/binge eaters it also helps to record the emotions associated with “emotional” eating.
5. DO encourage your patient to develop some understanding and knowledge of caloric content of foods and drink.
6. DO recommend reducing “liquid calories”
7. DO recommend at least 30-60 min of daily physical activity; use a pedometer and record steps in food diary
8. DO offer regular “weigh-ins” (at least once a month)
9. DO NOT stop the above when patient stops losing weight – preventing weight regain needs more effort (AND SUPPORT) than weight loss!
10. DO treat recidivism for what it is – a natural and expected phenomenon of a chronic disease – GO TO step 3
At each visit:
1. Review any changes in lifestyle since last visit
2. Review any changes in eating pattern since last visit and review use of food diary
3. Review intake of “liquid calories”
4. Review emotional eating/snacking
5. Review physical activity and use of pedometer
6. Review weight changes (DO NOT BE JUDGEMENTAL!):
– if gaining: re-emphasize considering change
– if maintaining: compliment on effort; encourage change; consider meal replacements and/or medication
– if losing: compliment, but warn that weight loss is unlikely to continue at present rate, manage expectations (5-10% weight target), focus on health and QoL improvements rather than weight lost
Obviously, this is the bare minimum. If obesity management was really that simple, we would not have an obesity crisis.