Understanding, Valuing The Medical Journey to Weight Loss

Editor’s note: This is a column by Ravneet Nagi, MD, a primary care doctor specializing in Family Medicine, Obesity Medicine, and Travel Medicine. The presented analysis reflects their views, not necessarily those of the publication. Nagi is certified by the American Board of Family Medicine and Obesity Medicine, and she is a member of the American Academy of Family Physicians. She also has experience serving as a teaching attending for Lenox Hill Hospital, NY, and as a teaching attending nurse practitioner students at the University of Texas.

Health care professionals and researchers interested in responding to this piece or similarly contributing to MD Magazine® can reach the editorial staff by submitting a request here.

Ravneet Nagi, MD

As a primary care physician with a focus on obesity and weight loss, I have come to realize the importance of destigmatizing obesity as a self-created problem and instead treating it like a medical condition such as hypertension or diabetes. The goal of medical weight loss is to help patients achieve metabolic improvements, which require a loss of 5-10% of excess body weight.

The benefits of this type of weight loss include the following:

• Diabetes prevention

• Reversing prediabetes

• Improvements in hypertension, heart disease risk, and osteoarthritis

Rather than focusing on the aesthetics of weight loss, most physicians help patients focus on the metabolic benefits. The body positivity movement has had such an impact; physicians can achieve the metabolic benefits of weight loss, while the patients embrace their different body types.

The paradigm of obesity is complex and requires a multi-disciplinary approach, but it is one of the most gratifying experiences for both the physicians and patient when they see the results of weight loss. I have had greater success when I approach obesity as a disease entity with a complex hormonal imbalance and not as a self-created stigma of poor lifestyle choices.

In our office, we discuss patient weight, height, and body mass index (BMI) as part of their vital signs during intake, as well as during their patient encounter with the physician. We use tools like motivational interviews to gauge patients’ receptiveness for starting a weight loss program.

A detailed history is obtained on their first visit including a list of previous diets, medications that patients may have used for weight loss, eating habits and the patient's motivation for losing weight. It is beneficial to conduct lab work for prediabetes, cholesterol, thyroid disease, liver function, and other endocrine disorders before starting any treatment.

It has also proved beneficial to have frequent office visits with the patients during the initial phase of their treatment regimen to evaluate treatment response, address any concerns and re-tailor the therapy if needed. Group therapy and support groups have been beneficial for patients to interact not only with their physician, but also with peers on the same wellness journey. The give-and-take in this setting often motivates them further as they can see real results in their peers. In our practice, we customize meal plans and prescribe US Food and Drug Administration (FDA)-approved low-dose phentermine medications for weight reduction.

Patients experience significant roadblocks during their weight loss journey. The culture of fast food, with its high sugar content, large portion sizes and relatively low cost has led to an epidemic of obesity and medical problems in all age groups. We are now seeing younger patients, including kids and adolescents with hypertension, and type 2 diabetes—diseases that were usually more prevalent in the older age groups.

Complicating the obesity epidemic in this country is the fact that there is a social stigma attached to taking weight loss medications. Insurance coverage is another huge problem in our field, even for all FDA-approved medications. Unlike traditional diseases, there is little to no coverage provided for weight loss therapy such as nutritionist consults, or meal replacement plans, which are the cornerstone of weight loss programs.

These treatments, by themselves, are often expensive and a financial burden for patients to stay on for a long term. They disproportionately affect the socio-economic segment of the population most in need of these services.

Now that obesity is starting to be recognized as an endocrine disease with its complex manifestations, it behooves us to address it as such, to separate the patient from the disease and destigmatize it.

The medical society in the United States should work towards addressing the problem of obesity at an early stage which will improve patient outcome, and in the long run, save insurance companies millions of dollars while giving the patient a better quality of life.