- Email: [email protected]
Just Eat Less and Exercise More?
Obesity Management in Primary Care
Foreword Just Eat Less and Exercise More?
Joel J. Heidelbaugh, MD, FAAFP, FACG Consulting Editor
It is with great excitement that I present this issue of Primary Care: Clinics in Office Practice dedicated to the topic of obesity management, which remains a prevailing challenge in our daily practices, and a perennial national health care crisis. While national societies have developed guidelines, and various interest groups have created many useful provisions for strategic education and intervention, the pediatric and adult obesity rates in the United States remain alarming. We, the ever-busy health care practitioners, are perfectly skilled in sheepishly telling our patients to “just eat less and exercise more,” which rarely cuts the mustard (sorry, I couldn’t resist.). We also still fall well short of providing preprofessional (Liaison Committee on Medical Education nutrition education requirement is less than 5 hours over 4 years) and resident education on HOW to motivate and educate our obese patients toward reasonable weight loss goals and HOW to empower them to be successful. The concept and causation of obesity absolutely fascinate me. Thinking back to high school in the 1980s, I can think of only a few kids in my school who were really obese, and that would likely pale in comparison to obesity standards today. We all imbibed soda, ate chips and cookies, and watched MTV, video games, and other garbage, and somehow didn’t become obese to the extent that kids are today. So what has changed? Are kids today just eating more bad calories and getting less exercise? Are there genetic switches that have been activated to modify hormone regulation through environmental factors that we haven’t identified and developed drugs to combat? A recent well-child examination for a 12-year-old, 5-foot, 4-inch, 266-pound (BMI 45.7) asthmatic boy presented this difficult discussion with his mother: “Dr. H, you’ve gotta tell my son to stop eating so much. He won’t listen to me. I found cookies under his bed and empty soda bottles on the floor. He watches too much television and constantly plays video games on his cell phone. It’s impossible to get him to do his homework. He complains when I give him vegetables. Every day after school he wants me to take him to McDonald’s because he’s hungry”.
Prim Care Clin Office Pract 43 (2016) xiii–xiv http://dx.doi.org/10.1016/j.pop.2015.10.006 0095-4543/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
primarycare.theclinics.com
xiv
Foreword
So, what would you do? How effective do you think you can be in motivating and educating this child to make changes? How would you teach his mother to take control by creating dietary and activity limitations for her son? How would you feel about having a child with pediatric obesity on your patient panel, for which you are held accountable for outcomes under the provisions of population management? This issue of Primary Care: Clinics in Office Practice begins with a summary of harrowing statistics on obesity, much of which we already know, but which are presented in a novel fashion that allow us to better understand the data on who are most susceptible and afflicted by obesity and comorbid factors. The next article details the economic burden of obesity, again which we can likely estimate, but continually underestimate and often take for granted that it will just multiply. We all play a role in prevention on the “micro,” or patient-to-patient level, yet will now have enhanced knowledge and skills to become better advocates for the “macro” level change in our communities. The article on national health care policy on obesity management is outstanding, with a review of current strategies for legislation and changes in food manufacturing and preparation. The article that highlights the model of the patient-centered medical home provides an exemplary construct for a multidisciplinary approach toward obesity management. This includes utilizing our resources of health educators and coaches, dietitians, and exercise physiologists, coupled with harnessing our own potential for obesity education and management. These principles play key roles across all populations, from children and adolescents to adults, including pregnant women. The promise of pharmacologic management is reviewed, as novel therapies are presented with reference to their basis in pathophysiology and endocrinology. Last, a review of surgical therapies for obesity is provided, highlighting vast successes in weight loss management over the last few decades, with rapid advancements in surgical techniques and impressive decreases in morbidity and mortality rates. I would like to thank Dr Mark Stephens and his authors for creating a wonderful compendium of articles on the important topic of obesity management. As usual, I Googled many of the authors of the articles within this issue to learn about their expertise. Impressively, all are highly visible experts in the fields of clinical medicine and surgery with a focus on nutrition and epidemiology centered on teaching, creating written and video educational tools, and promoting public health initiatives to combat obesity. This issue provides a substantial amount of useful information for the practicing clinician, researcher, and medical educator. What I gained most from this issue is that we can collectively become greater motivating factors in our patient’s lives and partner with them to lose weight and improve their health outcomes. I’ll never look at another tortilla chip or video game the same way again.. Joel J. Heidelbaugh, MD, FAAFP, FACG Departments of Family Medicine and Urology University of Michigan Medical School Ann Arbor, MI 48109, USA Ypsilanti Health Center 200 Arnet Suite 200 Ypsilanti, MI 48198, USA E-mail address: [email protected]
Foreword Just Eat Less and Exercise More?
Joel J. Heidelbaugh, MD, FAAFP, FACG Consulting Editor
It is with great excitement that I present this issue of Primary Care: Clinics in Office Practice dedicated to the topic of obesity management, which remains a prevailing challenge in our daily practices, and a perennial national health care crisis. While national societies have developed guidelines, and various interest groups have created many useful provisions for strategic education and intervention, the pediatric and adult obesity rates in the United States remain alarming. We, the ever-busy health care practitioners, are perfectly skilled in sheepishly telling our patients to “just eat less and exercise more,” which rarely cuts the mustard (sorry, I couldn’t resist.). We also still fall well short of providing preprofessional (Liaison Committee on Medical Education nutrition education requirement is less than 5 hours over 4 years) and resident education on HOW to motivate and educate our obese patients toward reasonable weight loss goals and HOW to empower them to be successful. The concept and causation of obesity absolutely fascinate me. Thinking back to high school in the 1980s, I can think of only a few kids in my school who were really obese, and that would likely pale in comparison to obesity standards today. We all imbibed soda, ate chips and cookies, and watched MTV, video games, and other garbage, and somehow didn’t become obese to the extent that kids are today. So what has changed? Are kids today just eating more bad calories and getting less exercise? Are there genetic switches that have been activated to modify hormone regulation through environmental factors that we haven’t identified and developed drugs to combat? A recent well-child examination for a 12-year-old, 5-foot, 4-inch, 266-pound (BMI 45.7) asthmatic boy presented this difficult discussion with his mother: “Dr. H, you’ve gotta tell my son to stop eating so much. He won’t listen to me. I found cookies under his bed and empty soda bottles on the floor. He watches too much television and constantly plays video games on his cell phone. It’s impossible to get him to do his homework. He complains when I give him vegetables. Every day after school he wants me to take him to McDonald’s because he’s hungry”.
Prim Care Clin Office Pract 43 (2016) xiii–xiv http://dx.doi.org/10.1016/j.pop.2015.10.006 0095-4543/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
primarycare.theclinics.com
xiv
Foreword
So, what would you do? How effective do you think you can be in motivating and educating this child to make changes? How would you teach his mother to take control by creating dietary and activity limitations for her son? How would you feel about having a child with pediatric obesity on your patient panel, for which you are held accountable for outcomes under the provisions of population management? This issue of Primary Care: Clinics in Office Practice begins with a summary of harrowing statistics on obesity, much of which we already know, but which are presented in a novel fashion that allow us to better understand the data on who are most susceptible and afflicted by obesity and comorbid factors. The next article details the economic burden of obesity, again which we can likely estimate, but continually underestimate and often take for granted that it will just multiply. We all play a role in prevention on the “micro,” or patient-to-patient level, yet will now have enhanced knowledge and skills to become better advocates for the “macro” level change in our communities. The article on national health care policy on obesity management is outstanding, with a review of current strategies for legislation and changes in food manufacturing and preparation. The article that highlights the model of the patient-centered medical home provides an exemplary construct for a multidisciplinary approach toward obesity management. This includes utilizing our resources of health educators and coaches, dietitians, and exercise physiologists, coupled with harnessing our own potential for obesity education and management. These principles play key roles across all populations, from children and adolescents to adults, including pregnant women. The promise of pharmacologic management is reviewed, as novel therapies are presented with reference to their basis in pathophysiology and endocrinology. Last, a review of surgical therapies for obesity is provided, highlighting vast successes in weight loss management over the last few decades, with rapid advancements in surgical techniques and impressive decreases in morbidity and mortality rates. I would like to thank Dr Mark Stephens and his authors for creating a wonderful compendium of articles on the important topic of obesity management. As usual, I Googled many of the authors of the articles within this issue to learn about their expertise. Impressively, all are highly visible experts in the fields of clinical medicine and surgery with a focus on nutrition and epidemiology centered on teaching, creating written and video educational tools, and promoting public health initiatives to combat obesity. This issue provides a substantial amount of useful information for the practicing clinician, researcher, and medical educator. What I gained most from this issue is that we can collectively become greater motivating factors in our patient’s lives and partner with them to lose weight and improve their health outcomes. I’ll never look at another tortilla chip or video game the same way again.. Joel J. Heidelbaugh, MD, FAAFP, FACG Departments of Family Medicine and Urology University of Michigan Medical School Ann Arbor, MI 48109, USA Ypsilanti Health Center 200 Arnet Suite 200 Ypsilanti, MI 48198, USA E-mail address: [email protected]