Week 9 Obesity in Primary Care Flashcards

Question

Weight loss devices chart

Answer 1

BMI of 30 kg/m2 or higher

Answer 2

* Affordable Care Act (ACA) 2010 * Obesity-related services = preventive services * Medicare Part B * Screening and behavioral counseling services for ≥ 30kg/m2 * Some bariatric surgery (RYGB, LSG) * Medicaid & CHIP * Coverage varies by state * Obesity screenings, Weight loss medications, Bariatric surgery, Nutrition counseling

Answer 3

* Month 1: Face-to-face, once weekly * Month 2-6: Face-to-face, once every other week * Requirement: Documented 3kg weight loss * If not achieved re-assess for 6 months * Month 7-12: Face-to-face, once monthly * Reassess readiness to change and BMI

Answer 4

* Screening for obesity in adults using measurement of BMI - doesn't account for composition (not use in kids, or sarcopenia) * Dietary (nutritional) assessment; and * Intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high intensity interventions on diet and exercise

Answer 5

* **Ask** permission to address weight * **Assess** the patient’s desired weight loss goal and reasons for wanting to lose weight * **Advise** about treatments that match the patient’s goals and are likely to produce desired results. * **Agree** on weight loss, lifestyle, and behavioral goals * **Assist** the patient by creating a plan

Answer 6

1. Pre-Contemplation: No intention of changing behavior in the foreseeable future. Pt will tend to be unaware that they have a problem & are resistant to efforts to modify the behavior. May be aware they have a “health issue” or that their practitioner is “worried”, but they may think there is nothing wrong. 2. Contemplation: Aware they have a problem and are seriously thinking about changing, but have not yet made a commitment to taking action in the near future. 3. Preparation: The stage of decision making. A commitment is made to take action w/i the next 30days and are already making small behavioral changes. “I already went out and did all the grocery shopping; or I’ve already talked to my boss about changing my schedule at work.” 4. Action: Notable effort to change are made on a daily basis and they have now modified the target behavior to an acceptable criteria. Maintenance: Work is done to stabilize their behavior change and avoid relapse, sustaining their actions for at least 6mos. With weight loss, maybe closer to 1-2yrs.

Answer 7

* Constructive and reflective communication used to help reduce health risk and change behavior * Goal: identify difference between a pt’s current behaviors and his/her desired goals. * Understand ambivalence and ‘resistance’ (“non-compliance”) is part of the process; and that it is different from lack of motivation. * “OARS” = open-ended questions, affirmations, reflections, summarization * Offers advise and helps create a plan not direct

Answer 8

* Encourage/support diet, exercise and behavior modification * Utilize approved weight loss medications for long-term weight maintenance, through the amelioration of obesity complications and amplify adherence to behavior change. * Discussing and referring to bariatric surgery * Guidelines based on obesity complications and efficacy

Answer 9

* Highest adult weight? Lowest adult weight? Goal (weight)? * Preoperative weight? Discharge weight? Nadir weight? Goal weight? * Weight loss attempts in the past? Successes? How much lost? How? * Relapsed and weight gain? What was the trigger/barrier? * Medications, Devices &/or Bariatric Surgery: Have they had? Considered? Are they interested? * H/o eating disorder? * Ask about their "Typical day" of food and liquid intake * Exercise, Sleep, stress management

Answer 10

lowest weight achieved after surgery

Answer 11

Current Health Status—Smoking history? Drug use? Immunization? Age-appropriate screenings AFAB w/bariatric surgery – higher risk of developing osteopenia or osteoporosis PMHx/PSHx—Weight related complications. Are there contraindications to the usage of medications, devices, surgery? Are there contraindications to the weight loss process at all? Are there other causes of weight gain? FamilyHx—Give an insight to possible genetic factors for obesity, risk for complications, surgical support PsychoSocialHx—Social issues, mental health history, eating disorder history, SDOH (education, employment, housing, supplemental income, food insecurity) Some with low health literacy may not know about “portion sizing”

Answer 12

Not a comprehensive list

Answer 13

Vitamin B deficiency – Look for nystagmus = Wernicke’s encephalopathy Check B1 – if normal --> alcoholism Bariatric surgery – neuro exam Want patients to move – resp and MSK – see if they have any weakness Dumping syndrome post gastric bypass: glucose gets absorbed quicker – diarrhea, sweat (feel sick) (educate about timing and types of trigger foods) GERD – reflux syndromes with gastric sleeve

Answer 14

Complications

Answer 15

Look for complications if they didn’t have bariatric surgery Stretch marks/striae - flesh tone instead of purple (cushing’s)

Answer 16

R/o thyroid always – rare that it’s hypothyroid cause of obesity (lose 10lbs if tx hypothyroidism)

Answer 17

* Acknowledge obesity as a multifactorial chronic disease * Communicate the health complications a/w overweight & obesity. * Use a weight-centric approach to managing obesity related complications * Prescribe medications for weight loss and adjust during the weight loss process. * Be a guiding light for your pts and help them achieve meaningful weight loss

Week 9 Obesity in Primary Care Flashcards

(44 cards)