Creating a Treatment Plan

Introduction

The treatment of obesity should be based upon the degree of adiposity and the prevalence and risks of weight-related comorbidities. A higher risk patient may require a more aggressive intervention such as pharmacotherapy and surgery. All plans should be flexible to accommodate an individual’s needs and preferences. The Algorithm for the Medical Care of Patients with Obesity published by the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) in 2016 provides an obesity-specific treatment algorithm for the management of patients with overweight or obesity.

In addition, Figure 5-3 is the treatment algorithm from the 2013 AHA/ACC/TOS Guideline For The Management Of Overweight And Obesity In Adults. It is based on the Chronic Disease Management Model for Primary Care of Patients with Overweight and Obesity to guide PCPs in the evaluation, prevention and management of patients regarding excess body weight. The algorithm is not intended to supplant initial assessment for CV risk factors or diseases but rather focuses on the identification of patients with excess body weight and those at risk for obesity-related health problems. Its purpose is to guide weight management decision making. This intervention should be a foundation for additional weight management efforts, such as addition of medications or bariatric surgery.

All treatment programs should include a comprehensive team approach and may include a physician, registered dietician, social worker, psychiatrist, nurse and surgeon. Effective management requires sufficient time and frequent monitoring in order to keep the patient motivated and provide accountability. Once a patient achieves a reasonable goal weight, it may take as much, if not more, time to maintain the weight loss. Given that obesity is a chronic disease, it is paramount that patients have long-term monitoring in order to help prevent weight regain.

Enlarge 

Realistic Goal Setting

Patients often have unrealistic expectations about how much weight they would like to lose. It is not necessary to achieve an “ideal” body weight or normal BMI because health benefits are often achieved when a patient loses as little as 5% to 10% of their total body weight. The rate of weight loss is not necessarily important, however, usual goals target approximately 1-2 lb/week over the course of 6 months. Goal setting should occur in conjunction with the patient and may be modified over time. Weight loss alone should not be the only aim of treatment, rather improvement in obesity-related comorbidities should be a primary goal and monitored throughout treatment . Long-term treatment plans should be in place to assist with weight maintenance and avoidance of weight regain.