In addition to today’s resource, please see and review the New York Times article, The Risks of Taking Drugs Like Ozempic When You’re Over 65: Medications that cause drastic weight loss raise specific concerns for older adults. By Dani Blum
July 17, 2023

In addition to today’s resource, please see and review Links To And Excerpts From Two Articles On Superabsorbent Oral Hydrogel For Weight Loss with Links To Additional Resources On Pharmacologic Weight Loss Treatment
Posted on July 24, 2023 by Tom Wade MD

In addition to today’s resource, please see and review Links To And Excerpts From The Curbsiders’ #324: Obesity Medicine FAQ with Dr. Fatima Cody Stanford
Posted on March 20, 2022 by Tom Wade MD

Today, I reviewed, link to and excerpt from The Curbsiders #405 Obesity Medicine, GLP1 agonists, Weight Loss Management Tools and Tips*, July 24, 2023 | By Matthew Watto, MD.

This podcast is full of outstanding practical tips and should be reviewed over and over.

*Watto MF, Gudzune KA, Williams PN, Witt L. “#406 Obesity Medicine, GLP1 agonists, Weight Loss Management Tools and Tips”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast Final publishing date July 24, 2023.

All that follows is from the above outstanding podcast show notes.

Download The Transcript

Hone your obesity medicine skills in primary care! We discuss overcoming barriers, patient counseling, obesity pathophysiology, motivational interviewing, tools and tips from a weight loss program, and how to discuss medications for weight loss including phentermine/topiramate, bupropion/naltrexone, orlistat, oral superabsorbent hydrogel, and GLP1 agonists. We’re joined by obesity medicine expert, Dr. Kimberly Anne Gudzune of @HopkinsMedicine, recorded @SocietyGIM #SGIM23 in Denver, Colorado

Show Segments

• Intro
• Barriers to treating medicine in primary care
• Patient counseling and obesity pathophysiology
• Motivational Interviewing
• Telemedicine for obesity
• Tools and tips for a weight loss program
• Medications for Obesity
• GLP1 agonist prescribing tips
• Outro

Obesity Medicine Pearls

1. Obesity is a chronic disease! It requires chronic management.
2. Be sure to mention the diagnosis of obesity to patients because they may read it in their chart.
3. Ask about functional limitations (inability to play with their kids) and the psychological impacts of obesity as potential motivating factors for patients instead of solely focusing on the metabolic impacts of obesity.
4. Weight regain is common because weight loss triggers the body to increase appetite (hunger), and slow the metabolic rate to get back to the previous “set point”. Thus, prevention of obesity is key!
5. Telemedicine can be used to achieve the frequent patient contact crucial to weight management.
6. Tracking food intake can be helpful for patients with obesity, but is contraindicated in patients with an eating disorder! Screen with the SCOFF questionnaire.
7. Patients taking a GLP1 agonist should cut portion sizes in half to reduce nausea and increase fiber intake to avoid constipation.
8. Recommend adequate protein intake and resistance training to patients on a GLP1 agonist to mitigate muscle loss.

Obesity Show Notes

Barriers to Discussing Obesity

Potential provider-level barriers to addressing obesity in the primary care setting  Oshman, 2023).

• Lack of confidence in their abilities
• Worried about offending the patient
• Patient did not bring up weight loss
• Time-consuming
• Lack of billing/reimbursement

Dr. Gudzune points out that most physicians lack training in weight loss management. Further, some PCPs worry about lack of reimbursement for time spent discussing obesity, but obesity codes are often now reimbursed.

Kashlak Pearl: Schedule a separate visit to discuss weight management options to allow the appropriate time.