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New AACE obesity module, tool kit stress importance of patient-centered practices
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NASHVILLE, Tenn. – The American Association of Clinical Endocrinologists unveiled a new module and tool kit for obesity medicine, designed to focus more closely on disease complications and less on BMI, while also providing a framework for clinicians to provide more comprehensive care for patients with obesity.
The initiative, introduced during a special session at the 24th annual AACE Annual Scientific & Clinical Congress, recommends strategies for discussing obesity with patients, an obesity-focused review of systems and best practices to equip and staff an office for obesity medicine.
AACE declared obesity a disease in 2012, citing clinical evidence that identifies obesity as a hormone-based disease state, producing signs, symptoms and morbidities which meet the AMA’s established definition of a disease.
“If we’re going to treat [obesity] as a disease, we need to make some decisions on how we use our treatment modalities,” said W. Timothy Garvey, MD, FACE, chair of the AACE Obesity Scientific Committee.
W. Timothy Garvey
Several obesity guidelines are currently available, Garvey said, but they lack evidence-based analysis and cannot be applied to all patients with obesity, like those who have weight-related complications.
“They tend not to be comprehensive,” Garvey said. “They’re built around a limited number of questions … they can’t all be put together into a comprehensive treatment plan.
“The more complication-centric you are allows you to target those patients who will most benefit from weight loss, thereby enhancing benefit risk,” Garvey said.
Pearls for practice
Components of the obesity module, based on the obesity algorithm that is part of the AACE/ACE Comprehensive Diabetes Management Algorithm and the Advanced Framework for a New Diagnosis of Obesity, include tips on preparing clinicians’ offices for obesity medicine, approaches for discussing obesity as a disease with patients and the anthropometric and clinical component of the diagnosis using body mass index (BMI) and waist circumference.
J. Michael Gonzalez-Campoy, MD, PhD, FACE, director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology, said it is important to reframe language to be more patient-centered when discussing obesity. Clinicians, for example, should avoid using “overweight” or “obese” as adjectives, Gonzalez-Campoy said.
J. Michael Gonzalez-Campoy
“That little semantic distinction is very powerful in creating an environment that is welcoming to patients,” Gonzalez-Campoy said in a special session addressing the new module.
“You want to provide from the very beginning an atmosphere of empathy and understanding,” Gonzalez-Campoy said. “They have a disease.”
BMI, Gonzalez-Campoy said, is not a “pure predictor” of health risk, adding that waist circumference also needs to be considered.
“As waist circumference goes up, the risk of death goes up,” Gonzalez-Campoy said. “It doesn’t matter what BMI you’re talking about.”
When treating obesity, it is important to follow the same model as any other chronic disease. This includes, according to Gonzalez-Campoy, conducting an initial assessment, instituting treatment, patient and family education, quarterly office assessments and periodic screening for complications and risk re-stratification.
Effective behavior modification can be achieved, Gonzalez-Campoy said, by setting realistic goals – ideally to lose 5% to 10% of current body weight over 6 to 12 months.
“You apply the model of chronic disease management to every application,” Gonzalez-Campoy said. “Is it doable? Yes. The key is to be persistent and patient.”
Patient, office considerations
The module also includes recommendations on how to prepare clinicians’ offices for obesity medicine, including having appropriately sized furniture, wide doors and passageways, an accurate platform scale and appropriately-sized blood pressure cuffs, examination gowns and wheelchairs.
A welcoming front desk staff, properly trained in how to address patients with obesity, is also important, Gonzalez-Campoy said. Other module components include assistance with decisions on proper therapy and logistics, finances and coding for a successful obesity medicine practice.
“These tools are to allow a more efficient patient flow and evaluation, and tools for strategic coding and remuneration,” Garvey said.
The module and tool kit offer a more comprehensive approach, Garvey said, taking into account individual patient needs and addressing the specific needs of health care providers who treat patients with obesity. New evidence-based obesity guidelines from AACE will likely follow this fall, Garvey said, as well as an obesity white paper and continuing medical education programs.
“I think we really have a lot of work to do in creating evidence-based guidelines of practical use for people taking care of patients in the real world,” Garvey said.
A second consensus conference on obesity is planned for early 2016, Garvey said.
“We want to take our guidelines, bring together different professional societies …talking with one voice and not confusing clinicians and advance obesity medicine in that way,” Garvey said. “That’s our future plan.” —by Regina Schaffer
Reference:
Garvey WT, et al. W12. Presented at: AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.
Disclosure: Garvey reports that he has received advisory board honoraria and research support from various pharmaceutical companies. Gonzalez-Campoy reports honoraria, speaker and/or consultant relationships with Astra Zeneca, Eisai, GlaxoSmithKline, Janssen, Novo Nordisk, Takeda, ValenTx and Vivus.