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Podcast Recap | Curbsiders: Obesity medicine, GLP1 agonists, weight loss management tools and tips

August 24, 2023

With so much focus on GLP-1 agonists potentially being prescribed as a quick fix for weight loss management, many health care professionals like Kimberly Gudzune, medical director of the American Board of Obesity Medicine and an associate professor of medicine at Johns Hopkins are increasingly focused on a holistic approach to obesity prevention and management. Curbsiders hosts Dr. Matthew Watto and Dr. Paul Nelson Williams interview Dr. Gudzune about the best ways to counsel patients diagnosed with obesity and best practices for implementing evolving and progressive medications into patient treatment plans.

Podcast length: 55 min., 16 sec.

5 Keys Takeaways

1. There are many barriers to addressing and treating weight gain that healthcare professionals must overcome to help their patients.

Obesity and weight loss are not discussed in the healthcare setting as much as they should be for various reasons. Some healthcare professionals indicate they avoid the topic altogether, as they do not want to alienate their patients. In contrast, patients are likely waiting for their healthcare provider to bring it up. Asking permission from the patient to discuss weight gain/weight loss is one way to lead into the conversation and give the power back to them. Insurance reimbursement rates are another barrier physicians face when discussing obesity and weight loss. In addition, the fact that patients can now access their entire health record online through web applications may make providers hesitant to add a diagnosis such as “obesity” to their charts. Recognizing the barriers and working to overcome them will help physicians to address obesity in patients and treat it effectively moving forward.

2. Healthcare professionals should discuss various risk factors with patients regarding obesity and weight loss.

Many risk factors are present when a patient is obese or on a trajectory for obesity. While the severity and incidence of risk factors will vary from patient to patient, there are some that clinicians should address with patients so that they understand the potential consequences of this disease. There are obvious ones, such as heart disease, hypertension, and diabetes, but also functional limitations and psychological impacts that obesity has on a patient. Addressing the risk factors and how they could potentially impact patients’ lives are paramount discussions.

3. Telemedicine has been primarily positive for obesity management and treatment.

The COVID-19 pandemic changed medicine in so many ways, but one of the ways it has left a lasting impact is with the dramatic implementation and adaptation of telemedicine. While telemedicine was not a new concept when COVID hit, it was not widely used like it is now. COVID forced physicians to see their patients via video to avoid contact unless necessary. Telemedicine has revolutionized obesity medicine. Frequency of contact with one's healthcare team is vital during obesity management, and telemedicine has made this easier as accessibility increases. Not only is it easier and more convenient for patients to see their physicians via telemedicine, but they may also see a dietitian or psychologist via a telemedicine visit. While it is still crucial for physicians to see these patients in person, it is not necessary for every visit. This frequent contact allows for accountability and shared decision-making between the patient and their healthcare team.

4. There are a variety of medication options for managing a patient’s obesity.

Medication management is another treatment option if other interventions are unsuccessful, such as dieting, exercise, and other lifestyle modifications. Some medications were historically used for managing obesity, like orlistat and bupropion/naltrexone. Recently, there has been a shift to GLP-1 agonists and GIP/GLP-1 agonists for weight loss. These medications, typically used for diabetes management, are effective in curbing appetite and making the patient feel full faster, leading to sometimes rapid weight loss. Although these medications are showing success, they are difficult to get authorization from insurance, leading to cost considerations and discussions about the side effects. Deciding to start a medication for obesity is a decision that the patient and healthcare professional should share.

5. If patients choose to use a GLP-1 agonist medication, their healthcare provider should monitor them to ensure their safety and health.

The GLP-1 agonist medications seem to work so well that patients sometimes become frail, leading to concerns about body composition and muscle mass. Clinicians prescribing these medications should use bioelectric impedance analysis to study the patient’s fat and lean masses over the course of treatment. They should incorporate resistance training with the patient early on to retain as much muscle mass as possible. In addition, being mindful of the foods fueling the body is of utmost importance. Since the patient is eating less, ensuring they eat lean proteins and fibrous foods is important.

Obesity is a serious, costly, and unfortunately prevalent disease in the United States. Understanding how to best care for your patients can lead them to success in treating their obesity and related conditions. Treating patients with obesity takes a comprehensive approach with everyone taking part to reach the ultimate goal, health and safety for the patient.

Any views, thoughts, and opinions expressed in this podcast recap are solely that of the host and guests.

References

Watto, M. (2023, Jul 24). Obesity medicine, GLP1 agonists, weight loss management tools and tips. The Curbsiders: Internal Medicine. https://thecurbsiders.com/curbsiders-podcast/405-obesity-medicine-glp1-agonists-weight-loss-management-tools-and-tips.