Which Types of Providers Can Help Me with My Obesity?

For most people, body image, weight, and self-esteem are personal. We usually don’t like to discuss either our weight or our eating habits if we feel that this information will be received in a negative manner. Most people realize when they are gaining weight, but they might not realize just how much weight they have put on. It can be very disheartening for a person to realize that they have gone from “my pants are a little snug,” or “maybe they shrunk in the dryer?” to being classified as “obese” or in a “high-risk” category. It is sobering to see “obese” or “severe obesity” listed as a problem in your medical chart. Obesity is a complex, chronic, progressive, and life-threatening disease, especially when left unmanaged; it is not simply an indication that a person lacks discipline or motivation (Blackburn et al, 2008).

Don’t despair! The fact that you are even reading this guide is a good sign!

Accepting that you have obesity is the first—and maybe the most important— step to successful management of your weight. Many dedicated professionals in the medical community are available to help you take steps to lose weight and to achieve a healthy body mass index (BMI). This module discusses which professionals are best suited to help you face obesity.

Is Multi-Disciplinary Care Right for Me?

Multi-disciplinary care is beneficial for anyone who has found it difficult to lose weight, especially after having already attempted multiple serious efforts to lose weight. People who have just a few pounds to lose and who have not struggled with obesity might have success with lifestyle changes and routine monitoring from a health professional. If you are someone who has been trying to manage your weight through diet and exercise for as long as you can remember (and unable to lose weight), it might be time to consider a more holistic approach that involves medical professionals who are dedicated to your success. Multi- disciplinary care should include making small realistic steps toward establishing a permanent lifestyle change. A loss of only 10% of your weight is associated with significant health benefits. Small changes, such as improving the quality of your diet, adding regular physical activity, and enhancing the quality and duration of your sleep, can add up (Figure 14-1).

The BMI chart is used to determine your level of risk in relation to your weight and can help determine what interventions will be best for you now. To calculate your BMI, refer to module 5. Also, many BMI calculators are available on-line (for free).

Who Is on a Multi-Disciplinary Weight-Loss/Obesity Treatment Team and What Are Their Roles?

Primary-Care Physician/Family Physician

Hopefully you’ve already established a relationship with a Primary-Care Physician (PCP) with whom you feel comfortable and can trust. It’s important for you to be open and honest with your PCP about your struggles with your weight and concerns about your health. It can be helpful to keep a food journal for a few days and to record your diet, exercise, sleep, and other habits. This could help your PCP assess any areas that might need adjustments. Your PCP will also perform routine screening and discuss your risk factors.

As part of routine screening, your PCP might obtain some lab tests. These lab tests can help to determine the impact of your weight on your health. Your doctor has the final say on what tests will be needed based on your personal health history. Lab tests could include serum electrolytes, cholesterol levels, a lipid profile, an electrocardiogram (EKG) (to look at your heart rhythm), a hemoglobin A1C (to get an average of your blood sugar over the past 3 months), thyroid function tests (to rule-out hormonal causes of your weight gain), and liver function tests.

Endocrinologist

An endocrinologist is a doctor who specializes in the hormones of the body and their effects on health. Several hormone problems (e.g., polycystic ovarian syndrome [PCOS], hypothyroidism) can make it increasingly difficult to lose weight. Endocrinologists can screen for disorders of the thyroid, ovaries, adrenal gland, and pituitary gland disorders to be sure that these are not the cause of your obesity. There are also doctors called reproductive endocrinologists who can be helpful for women who find themselves struggling with infertility. Often, weight loss improves fertility, especially in patients with moderate to severe obesity. Reproductive endocrinologists can help with that condition.

Bariatric Surgeon

Bariatric surgeons are physicians who specialize in weight-loss surgery. Bariatric surgery can improve several conditions caused by, or worsened by, obesity. In general, to qualify for bariatric surgery, your BMI must be greater than 40 (or be at least 100 pounds overweight); your BMI is 35 or more and you have at least one obesity-related co-morbidity; or you have been unable to

achieve a healthy weight with previous attempts at weight loss. Psychological assessments are often completed before undergoing bariatric surgery. 

When behavioral and lifestyle changes have been unsuccessful for children and adolescents with obesity, more aggressive treatments like medications and possibly bariatric surgery might be required. The most common operations performed in children or adolescents affected by extreme obesity are Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and vertical sleeve gastrectomy. Of these procedures, the vertical sleeve gastrectomy is now the most commonly performed weight-loss procedure in the United States. The health-care team evaluates each individual with obesity and carefully weighs the pros and cons of surgery. Some insurance companies will not cover bariatric surgery for children under the age of 18.

Obesity Medicine Specialist

An obesity medicine specialist is a physician who is dedicated to the comprehensive care of people with obesity. They are comfortable using medications, behavioral interventions, and exercise regimens to combat obesity. Obesity medicine specialists receive additional training and certifications to better understand and address the issues that flow from obesity. Obesity medicine specialists understand and agree that obesity is a chronic disease that changes the way your body functions and must be managed over the long term.

Psychiatrist

A psychiatrist is a physician who specializes in the diagnosis and treatment of mental illness, eating disorders, and substance use disorders. Psychiatrists are trained to assess the mental and physical aspects of health problems. Psychiatrists can conduct talk therapy (psychotherapy), institute psychosocial interventions, and/or prescribe medications. Psychotherapy can be used to eliminate or control troubling symptoms so that you are better able to focus on addressing your obesity. Obesity can also be caused by medications called psychotropics that are used to treat mental disorders. Thus, it is important to include a psychiatrist in your multi-disciplinary obesity team (Chwastiak & Tek, 2014). If you have a psychiatric condition (like depression, anxiety, or bipolar disorder), you might need to continue receiving treatment for those conditions while addressing your obesity and overall physical health.

Psychologist

Psychologists are mental-health professionals who have doctoral-level degrees (PhD, PsyD, or EdD) and are trained to address a person’s stress or difficulty in life. As a part of any multi-disciplinary weight-loss program, it can be helpful to understand the underlying causes or behaviors that sabotage success. Before being approved for bariatric surgery, most patients must be evaluated by a mental-health provider. It is vital to understand whether psychological reasons contribute to your weight gain and to problem-solve to prevent them from becoming barriers to success. For instance, binge eating could complicate bariatric surgery; therefore, it is important to address this before undergoing surgery. When problems are unknown or unaddressed, patients might have poor surgical outcomes and fail to achieve their weight-loss goal over the long term.

Registered Dietitian

Dietitians can help develop eating plans that address specific diet quality considerations and can also address nutritional deficiencies that you might have. It is important to have a dietitian who is experienced with treating obesity. Dietitians who have been trained to work with someone who is undergoing bariatric surgery can be particularly useful to address specific nutritional deficiencies. Dietitians can help make sure that you’re able to follow dietary guidelines, eat proper portions, and make behavioral changes necessary to address your weight.

Physical Therapist

A physical therapist can teach you how to perform exercises that will help you to begin to become more active while losing weight. They are especially useful if you’ve had trouble with inactivity, or prior injuries, or if you lack knowledge on how to exercise safely. Physical exercise helps maintain weight loss, reduce your stress level, and improve your mood. A physical therapist can help you take the necessary steps to reach your goals while becoming physically stronger. You might discover a world of physical activity (e.g., biking, walking your dog, swimming) that you were previously unable to perform.

Pain Specialist

Unfortunately, chronic pain is associated with obesity for a variety of reasons. A pain specialist can help you with underlying issues that hinder your ability to exercise or function. Depending on your level of chronic pain, it might be difficult to get through the day. Exercise can help you to maintain weight loss and improve your sense of well-being. Pain specialists can help provide you with solutions for difficult-to-control pain while allowing you to focus on your weight loss (Schnitzer, 2017).

Case Manager/Social Worker

When handling difficult situations, related to medical illness or other problems, it can feel as though it is too difficult to manage on your own. You might not know how or where to find the appropriate care. Case managers and social workers can help you to achieve a better quality of life. There are several types of case managers, including juvenile case managers, mental-health case managers, and social-work case managers, just to name a few. The common ground for most case managers is that they advocate, educate, and provide emotional support for people in need. Case managers can assess your strengths and identify barriers that interfere with success. Case managers are vital to a well-run multi-disciplinary team because they can identify specific areas of need where you require more individualized help from others on the medical team. Case managers can help you understand insurance issues, make timely follow-up appointments, or find resources in the community. 

(https://www.psychologyschoolguide.net/social-work-careers/case-manager/). Case managers usually determine the best services available and then social workers perform the daily tasks to make sure that your goals will be met. Social workers work closely with you to help provide more regular support and counseling to help you stay on track. They also help make sure that you have access to resources in your community (https://www.casemanagementbasics.com/).

Thus, there are a host of dedicated members of the medical team who can help you address your obesity and struggles. You can begin by speaking with your PCP and determining your specific needs and risk factors. If you are ready to move forward on your weight-loss journey, consider researching the resources provided in this module and contacting a weight-management center in your area.

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