Treating Obesity in Primary Care

266 Pages·2020·4.054 MB·English

by  Angela Golden

Treating Obesity
in Primary Care
Angela Golden
123
Treating Obesity
in Primary Care
Angela Golden
Treating Obesity
in Primary Care
Angela Golden
NP from Home, LLC
Munds Park, AZ
USA
ISBN 978-3-030-48682-2 ISBN 978-3-030-48683-9 (eBook)
https://doi.org/10.1007/978-3-030-48683-9
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Thanks to Mike, you have
supported me in every
adventure I have decided
to go on—and writing this
book was an adventure!
To all my patients and
the colleagues that have
supported me in learning
to treat obesity—thank you
for the honor of knowing
you and please keep
teaching me.
And to my mom, dad, sibs,
sons, daughters-in-law, and
grandchildren, your love
and never-ending faith in
me kept me supported.
Preface
To best treat obesity, the clinician must first understand the
environment the patient has experienced in receiving health-
care and clearly recognize the underpinnings of obesity as a
disease. The pathophysiology of the disease and its complica-
tions can help guide treatment.
Evaluating obesity in the chronic disease model will pro-
vide primary care with a structure that is familiar to clinical
practice. The details of using evidence-based practice recom-
mendations with the foundational components of the obesity
treatment plan; eating plans, physical activity, and behavioral
interventions will be covered. Then reviewing the supportive
treatment of medication and/or surgeries, procedures and
devices.
After completing the education on obesity as a disease and
current treatment options, the next step is putting this into
practice in a busy primary care clinic. Several examples of
how this can be accomplished have been provided, including
billing information, so that the practice can be paid for the
work being done.
Munds Park, AZ, USA Angela Golden
Contents
Part I U nderstanding the Disease
1 B ias and Stigma Related to Patients with Obesity . . . . 3
Introduction ................................... 3
Bias .......................................... 4
Barriers ....................................... 7
Most Common Barriers from the Provider:
Time, Billing, Education . . . . . . . . . . . . . . . . . . 7
Office Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
References .................................... 12
2 O besity as a Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Introduction ................................... 13
So Is Obesity Really a Serious Chronic Disease? ... 14
Definition of a Chronic Disease . . . . . . . . . . . . 15
Obesity as a Chronic Disease . . . . . . . . . . . . . . 15
Why Do We Care if Obesity Is a Disease? ......... 18
Does Obesity Need to Be Treated? ............... 19
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Staging Obesity . . . . . . . . . . . . . . . . . . . . . . . . 22
Is It Even Important to Make a Diagnosis
or Can Just Treating the Complications
Be Enough? ................................. 23
References .................................... 24
3 Physiology of Adipose Tissue . . . . . . . . . . . . . . . . . . . . . 27
Introduction ................................... 27
Central Nervous System Control of Eating ......... 28
Physiology of Adipose Tissue .................... 31
x Contents
Future Use of Adipose Cells ..................... 35
Hormones .................................... 35
Leptin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
CCK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Adiponectin/Resistin . . . . . . . . . . . . . . . . . . . . 39
Ghrelin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
GLP-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Summary ..................................... 41
References .................................... 43
4 Pathophysiology of Obesity . . . . . . . . . . . . . . . . . . . . . . . 45
Introduction ................................... 45
Adiposity and Defense of Increased Adiposity ..... 46
Brain Disease .................................. 48
Endocrine Disease ............................. 49
Infectious Etiology ............................. 49
Genetic Factor ................................. 50
Inflammation .................................. 51
Endocrine-Disrupting Chemicals ................. 51
Microbiome ................................... 52
Inflammation .................................. 52
Behavior ...................................... 52
Smoking Cessation ............................. 53
Weight Regain ................................. 53
So What Is Metabolic Adaptation? . . . . . . . . . . 55
Are There Any Benefits Even with Weight
Regain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Clinical Practice Implication . . . . . . . . . . . . . . . 56
Conclusion .................................... 57
References .................................... 58
5 Obesity-Related Complications . . . . . . . . . . . . . . . . . . . 61
Introduction ................................... 61
All-Cause Mortality ............................ 64
Cancer ....................................... 64
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 66
Liver ......................................... 67
Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 68
Contents xi
Kidneys ....................................... 68
ORG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 69
Chronic Kidney Disease ......................... 69
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Clinical Mechanism . . . . . . . . . . . . . . . . . . . . . 69
Metabolic ..................................... 70
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Prediabetes .................................... 70
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Diabetes ...................................... 71
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Clinical Implication . . . . . . . . . . . . . . . . . . . . . 71
Metabolic Syndrome ............................ 72
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Clinical Indications . . . . . . . . . . . . . . . . . . . . . . 72
Cardiovascular ................................. 72
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 74
Atrial Fibrillation (Afib) ........................ 75
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 75
Heart Failure .................................. 75
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 76
Dyslipidemia .................................. 76
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 77
Hypertension .................................. 77
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 78
Polycystic Ovary Syndrome (PCOS)
and Female Infertility ......................... 79
Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 79
Male Hypogonadism. . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Clinical Implications . . . . . . . . . . . . . . . . . . . . . 80
Conclusion .................................... 83
References .................................... 83
xii Contents
Part II B uilding a Treatment Plan
6 C hronic Disease Model for Obesity . . . . . . . . . . . . . . . . 91
Introduction ................................... 91
Chronic Care Model ............................ 93
References .................................... 97
7 E vidence-Based Guidelines for the Treatment
of Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Introduction ................................... 99
Guidelines and Eating .......................... 103
Guidelines and Physical Activity ................. 104
Guidelines and Medications ..................... 104
Summary ..................................... 107
References .................................... 107
8 F oundational Component of Treating Obesity:
Eating Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
Introduction ................................... 109
Energy Balance Versus Quality Aka Quantity
Versus Quality .............................. 111
Eating Plans ................................... 112
Assessment ................................... 112
Eating Plans and Patterns ....................... 115
Macronutrient . . . . . . . . . . . . . . . . . . . . . . . . . 115
Meal Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Meal Patterning . . . . . . . . . . . . . . . . . . . . . . . . 118
Miscellaneous Issues. . . . . . . . . . . . . . . . . . . . . . . . 121
Fruits and Vegetables . . . . . . . . . . . . . . . . . . . . 121
Caloric Beverage . . . . . . . . . . . . . . . . . . . . . . . 121
Fast Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Protein at Breakfast . . . . . . . . . . . . . . . . . . . . . 121
National Weight Control Registry . . . . . . . . . . . 122
Angies’s Process of Guiding Patients .............. 122
References .................................... 123
9 F oundational Component of Treating Obesity:
Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
Introduction ................................... 127
Energy Expenditure ............................ 131