- Empathy
- Let Go of Weight Bias
- Avoid Weight Gaining Medications
- Do not Dismiss Viable Weight Loss Solutions
- Refer to an Obesity Specialist
- Be Empathetic
And if you can’t be empathetic be sympathetic. If you can’t be sympathetic, just be nice. It’s easy for me to start here because I have been 80 lbs heavier and I remember how different my life was back then. I was happy but I knew that I was not living to my top health potential. I am very empathetic to anyone who desires to lose weight because I know the challenges that are faced daily in fighting stubborn physiology. Many providers may never experience carrying excess weight but to be effective in treating your patients, understanding is paramount. Unfortunately studies tell us that in the medical field physicians have the highest weight prejudice against overweight patients; more so than any other healthcare provider. The irony is that the medical field is also the last resort for patients who seek to lose weight. Overweight patients will try commercial programs before asking a medical professional for assistance and will usually spend hundreds of dollars in failed weight loss programs before even considering our offices as an option.
As a provider you have 1 of 2 options for helping your patients with obesity, (1) to refer to an obesity specialist or bariatric surgeon (2) manage your weight loss patients, directly. If you decide to perform your own weight management always be sure to address patient barriers. This requires understanding obesity pathophysiology and remaining current on the newest weight loss options; both FDA approved and commercial. It is also essential to not simply suggest diet and exercise without providing specific detailed guidance. Always lead with compassion and refrain from blaming the patient for their weight. Fat shaming has unfortunately become all too common in our society. Some people use it as a method for motivation but it is never effective. Studies show that children who are ridiculed for their weight are more likely to gain weight. Being too harsh on your adult patients can have a similar effect. A supportive empathetic environment will yield better weight loss results and without it you are doomed to fail in helping your patient.
- Check Weight Management Bias At The Door
If you think weight loss is a soft science, you are sadly mistaken. It is very much a hard science. Nutrition is also a hard science, one that impacts physiology, biochemistry, hormones, genetic modification, and even alters the microbiota. Food has the power to activate and inactivate genes and metabolic pathways. Fat being the largest endocrine organ in the body has immense significance and for this reason fat is not easily “just lost”. Just losing weight is not an easy feat given it’s associations with thermoregulation, energy, hormone production, and most importantly survival. The body does not allow fat to be easily removed and has several counter reactions to block fat loss. The fat that we are able to lose goes through a heavily regulated process and only occurs when the biochemical mediators allow for it. When a patient loses weight, their neurochemical and digestive signaling changes. A mere 3% fat loss has the ability to dramatically change physiology; especially in patients with endocrine diseases. Not to mention overweight and obesity impact more body systems than almost any other disease, with over 200 co-morbid illnesses ranging from infertility to skin tags. There are over 50 etiologies for obesity and more being discovered year after year. Failing to recognize the intricacies of weight management is a common pitfall for both patients and providers. We tell people to eat less but do not realize that this also reduces basal metabolic rate or we counsel patients to exercise but do not prepare them for the up-regulation of hunger and cravings. Typically macronutrient balance, sleep, and stress are left out of weight management conversations altogether; despite the fact that they can make or break results. It is imperative to understand that weight loss is not simply calories in and calories out, it is biology, chemistry, neurology, psychology, and much more. People struggle with long-term weight loss because they underestimate this process and as a provider if you underestimate the treatment required for weight loss, you will fail to be effective in achieving lasting results.
- Avoid Weight Gaining Medications, When Possible
Warning! Please don’t be this guy. Don’t be the doctor who puts your patient with diabetes on insulin and then scratches your head wondering why they’ve gained 60 lbs in 9 months. Really? We have to remember our basic physiology. Insulin is a fat storing hormone, period. Insulin causes weight gain. Insulin increases appetite. Insulin increases cravings for sugar. Diabetics with obesity have sick inefficient muscle and will not process or eliminate insulin (via organs such as the kidneys and liver) effectively, making exogenous insulin even more potent for weight gain. I am of course not proposing that insulin be avoided in diabetic treatment. Insulin is vital and life saving for many patients. However, too many of us have chastised diabetic patients for gaining weight and making poor food choices. It was not until I started practicing obesity medicine that I realized that I was partly responsible for their weight gain. I found that providing specific solutions, as opposed to repetitive dietary visits, worked much better than watching the scale continue to climb. I also use weight reducing alternatives when appropriate. It is important to note, that our reflex to pile on more insulin should be very carefully evaluated, this typically leads to a downward spiral of more weight gain, erratic sugars, and it fails to address the real problem. Insulin is only one example of a weight gaining medication but perhaps one of the most common.
Below is a chart of additional medications associated with weight gain and alternatives that may help in weight neutralization or reduction.
| Medication Class | Medication Name | Alternative |
| Anti-Histamine | Diphenhydramine | Loratidine |
| Anti-Diabetics | Insulin TZD – actos Sulfonylurea -glyburide | Metformin Sitagliptin Canagliflozin GLP-1- Victoza, Byetta Acarbose |
| Psychiatric/Neurotropic | TCA Lithium Haldol SSRI Olanzapine Risperdone | Buproprion Ziprasidone |
| Beta Blocker | Metoprolol | ACE-I ARB |
| Calcium Channel Blocker | Amlodipine | |
| Corticosteroid | Methylprednisolone Prednisone Inhaled Corticosteroid – Budesonide | |
| Hormone | Estrogen, Progesterone | |
| Anti-seizure | Valproic Acid Gabapentin | Topiramate Zonisamide |
| Gut Stimulator | Metoclopramide | |
| Copyright 2017 © Melody Covington MD, Abundant Health & Vitality Inc | ||
- Do Not Dismiss Weight Loss Solutions
The negative stigma created by the early weight loss medication Fen-Phen (Fenfluramine-Phentermine) and even some of the early bariatric surgeries has negatively impacted the weight loss field. Weight loss is plagued by bariatric surgery weight recidivism and the idea that patients are taking “the easy way out”. Not to mention the commercialization and aggressive promotion of non-evidence based weight loss treatments. It is no wonder that providers are weary of what weight management can do for their patients. Diet and exercise are not the only solutions for weight loss and they are not always the best alternatives for every patient. Weight management must be personalized and it is our job to determine the specific mechanism that will work for each individual. For example, a 600 lb patient needs bariatric surgery. There is no debate. As a medical weight loss specialist, at the most, I can manage a 100-200 lb weight loss in a patient of this size but the time and requirements to do so are inefficient and risk the patient’s long term wellness. Limiting this patient to diet and exercise would be reckless given the mortality risk. I am honest with patients that not everyone will qualify for weight loss medication and that finding the right diet and exercise plans are the foundation to a successful weight loss program. I counsel patients on the fascinating options that exist today and what methods I feel would be their best solution. Medical weight loss is growing tremendously with several FDA approved weight loss medications (not just phentermine), non-invasive weight loss procedures, medical grade meal replacements, and new paradigms in diet and fitness. As a medical professional your attitude toward these treatments has the power to positively or negatively influence your patient and their progress. If we are going to solve this obesity conundrum we have to keep an open mind and go beyond just diet and exercise.
- Refer to an Obesity Specialist
Treating weight loss is not for everyone and as with everything in medicine, refer when necessary. An obesity specialist can be a great ally. Obesity specialists, also referred to as bariatricians want to support your patient but also want to support you. We know that chronic diseases improve with weight management and some diseases can even be completely eliminated. It gives us great satisfaction to see a patient transform and we look for opportunities to celebrate their weight loss success. We have the training, skills, and resources to create detailed treatment plans and effectively monitor weight loss in a safe environment. Weight loss can be frustrating for the patient and it can be hard to juggle amidst other visit complaints for primary care providers. We understand the difficulty in lifestyle changes and we celebrate weight maintenance as much as we celebrate weight loss. There are even times for celebrating weight gain. Through weight gain we learn new insight, strategy, vulnerability, and knowledge. I encourage you to get to know your local obesity specialists. Invite us to your offices, let us educate you and your staff on our practice philosophy, and let’s workout a plan for assisting with your patient’s weight loss prescription.
Reject ignorance surrounding weight loss medicine and at all costs avoid arrogance.
Check out our free tools to help treat obesity in your clinic such as our weight history chart, body measurements sheet, and food diary.
In the Charlotte area? Find out more about Abundant Health & Vitality Associates medical weight loss clinic here.
Interested in more blog articles? Check out “How to discuss weight loss with your doctor” here