In this post, I link to and excerpt from The Curbsiders’ #324: Obesity Medicine FAQ with Dr. Fatima Cody Stanford
FEBRUARY 28, 2022 By MATTHEW WATTO, MD*
Dr. Stanford is an advisor for Calibrate, a weight loss program that features telemedicine consults, coaching, and endorses medical weight loss medications as those discussed in this program. The Curbsiders report no relevant financial disclosures.
*Valdez I, McLellan M, Stanford FC, Williams PN, Watto MF. “#324: Obesity Medicine FAQ with Dr. Fatima Stanford”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list February 28, 2022.
All that follows is from the above outstanding resource.
Obesity treatment has been around since the 1950s but we’ve been underutilizing it for far too long! Not only that, we’ve been thinking about obesity the wrong way for decades. Join us with Dr. Fatima Cody Stanford (@AskDrFatima) of Massachusetts General Hospital as we reframe our approach to this disease and learn tips on prescribing older, but still very effective, medications used to treat obesity.
Obesity Medicine Pearls
- Obesity is a disease that can and needs to be treated with either surgery or medications. Obesity is NOT the patient’s fault.
- Help the patient determine a goal weight based on what they feel is their healthy point. Ask them the heaviest weight they’ve been; do not assume the weight they’re at during your visit is the heaviest.
- Some patients may already be very well-versed in managing a healthful diet so you might not always need to refer to dieticians
- Screen your patients for eating disorders. While the patient may be in remission from these disorders, their condition could recur while undergoing treatment.
- Studies show bupropion may elevate blood pressure and heart rate more often than phentermine.
- Monitor patient blood pressure and heart pulse while on medical treatment and especially if being treated with phentermine or bupropion.
- Topiramate can be used to help both weight loss and reduce night time cravings and should be dosed in the evenings.
- Naltrexone is known to cause nausea as a side effect and should be uptitrated weekly, or even monthly, to help reduce the incidence of nausea.
- Metformin is the only medication that could be used in pregnancy or breastfeeding as of the recording of this episode.
- Weight loss medications can be used in patients who’ve had bariatric/metabolic surgery if their weight loss plateaus or if they regain weight.
- BMI has historically been a skewed assessment of weight and obesity. Waist circumference measurements have a more direct impact on patient outcomes.
- Bottom line: weight loss is an individual journey. Medications and surgical intervention have different impacts in different patients.