Holly F. Lofton, MD NYU Langone Weight Management Program

Transcription

1 Holly F. Lofton, MD NYU Langone Weight Management Program

2 Disclosure page Holly Lofton, M.D. NYU Langone Medical Center Ownership interests: Eisai Speaker s Bureau: Eisai Will not be discussing the off label or investigational use of products.

3 Aldophe Quetelet

4 Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

5 Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14 15% 19% 20% 24% 25% 29% 30%

6 Obesity Timeline 2004 Medicare Coverage Manual 2008 The Obesity Society Supports Obesity as a Disease

7 June 13, 2013 AMA Officially Designates Obesity as a Disease

8 When Did YOU Begin to Treat Obesity? When WILL You Begin to Treat Obesity?

9 Why is Obesity Management Rare? Lack of time Lack of knowledge Lack of reimbursement Physician s overweight/ obesity Perception of patient Lacking in willpower, sloppy, futile to treat

10 Transition add picture of doctor talking to patient

11 So A Patient Walked in Today Male Age 40 Height 5 6 Weight 250 lb BMI 40 Blood Pressure 140/90 Lisinopril 20 mg RTC 1 2 months

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13 Why Treat Obesity In Your Office? Practice Proactively Reverse Metabolic Syndrome Not prescribe to mask symptoms Improve Fertility in Females Decrease Your Patient s Cancer Risk Minimize Medications, Procedures, Costs

14 Why Treat Obesity In Your Office? Reduce Sick Days/Visits Impact the Epidemic Adults and their children, families Increase Patients Life Span

15 Adding Weight Management To Your Practice ENVIRONMENT ESTABLISHING A TEAM KNOWLEDGE FOLLOW UP

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17 How Do Patients Feel? Embarrassed Fear of Being Weighed Low Self Esteem Victim of Bias Depressed/Avoidant Unfortunate/Forgotten

18 PHYSICAL ENVIRONMENT BARIATRIC CHAIRS/TABLES SCALES

19 COMFORTABLE ENVIRONMENT Waiting Room

20 COMFORTABLE ENVIRONMENT

21 PSYCHOSOCIAL ENVIRONMENT NON PUNITIVE ENCOURAGING SUPPORTIVE

22 What's in a Name? Patients Preferred Terms for Describing Obesity Obesity Research Volume 11, Issue 9, pages , 6 SEP 2012 DOI: /oby

23 What's in a Name? Patients Preferred Terms for Describing Obesity Obesity Research Volume 11, Issue 9, pages , 6 SEP 2012 DOI: /oby

24 MULTIDISCIPLINARY APPROACH PHYSICIAN REGISTERED DIETICIAN PSYCHOLOGIST EXERCISE PHYSIOLOGIST SURGEON NURSE ALTERNATIVE MEDICINE HYPNOSIS ACCUPUNCTURE MEDITATION

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26 Continuing Medical Education The Obesity Society American Society for Metabolic and Bariatric Surgery Obesity Week 2013 American Society of Bariatric Physicians Bariatric Practice Guidelines Industry Sponsored Programs Beware of Bias CDC Weight Management Research to Practice Series

27 National Weight Control Registry Low calorie, low fat diet Eat breakfast Reduce TV watching Accountability Limit diet variety CONSISTENT exercise Eliminate fast food

28 For Patients

29 Logistics Part Time or Full Time Dietary Surveillance and Accountability Frequent Follow up Medically Supervised VLCDs and LCDs Ketogenic Diets Meal Replacements Require Monitoring and Brief Training

30 Anorectic Medications Patient Selection BMI > 27 with co morbidities BMI > 30 without co morbidities Contraindications Medication Reconciliation Assess potential for interactions Informed Consent/ Documentation Follow up Appropriate Duration of Therapy

31 Eating Disorders When To Refer Worsening of Co Morbidities Unable to Maintain/Lose for 6 12 Months of Intensive Therapy Rapid Weight Gain Weight Gaining Medication Prescribed Immobility (expected)

32 Documentation/Billing Overweight/Obesity Related Co morbidities Metabolic Syndrome Weight Gain Impaired Fasting Glucose Polycystic Ovarian Syndrome 256.4

33 THANK YOU