How Can Primary Care Physicians Best Manage Patients with Obesity?
The obesity trend continues to rise in the United States with exceptionally severe consequences. Along with the exponential rise in obesity over the past several decades, we have seen a commensurate rise in type-2 diabetes, pre-diabetes, esophageal cancer and the incidence or worsening of many other cancers including breast, uterine and prostate. Unfortunately, the standard advice on how to lose weight, diet and exercise, begins to lose effectiveness once the patient becomes obese. Indeed, only about 5 to 10% of all of these patients are able to lose weight and maintain that weight loss over the long-term using diet and exercise alone. For those other 90 to 95% of patients, life can continue with yo-yo dieting, binge eating and a great deal of frustration that goes along with it. Similarly, weight loss pills are merely temporary solutions that will allow patients to regain the weight once the pill is no longer being taken.
With over 6 decades of experience with weight loss surgery and plenty of data, the medical community has shown a compelling case for bariatric surgery being not only the most effective, but truly the only long-term solution for the improvement of the metabolic disorders associated with obesity and morbid obesity. Over these years, we have understood that the excess weight causes far more than just an inconvenience and the ability to manage this weight becomes more difficult as the threshold to obesity is crossed. As a result, we have to treat and manage obesity as what it is – a full-fledged disease and national epidemic.
This concern has taken on even greater urgency because of research showing that obese patients are more susceptible to respiratory diseases such as the flu and even COVID-19, amongst others.
Unfortunately, while the disease of obesity has come to the forefront of the nation’s mindset, treatment for obesity has not kept up. Indeed, only about 10% of eligible patients actually have bariatric surgery every year, leaving 90% to fight this disease and consequent health problems. There are many reasons for this trend, not least of which is the reluctance of insurance companies to fully cover bariatric surgery as a front light treatment. However, there is also reticence both in the patient and medical community to choose surgery, often because of its past. Indeed, early bariatric surgery was quite risky and even more modern procedures such as the gastric band/Lap-Band have not shown the results that were promised.
The state of modern bariatric surgery
Today, bariatric surgery is performed more safely and effectively than ever before. The overall incidence of complications is under five percent, often even lower in the hands of an experienced surgeon. The mortality rate comes in at about .5%, roughly equal to that of a gallbladder removal. The point is that bariatric surgery has become routine and safe, especially when compared to leaving obesity unchecked. When taking into account the cost of obesity both in finances and in detriment to one’s lifestyle, bariatric surgery becomes a very compelling treatment that should be considered much sooner than it often is.
Ensuring the patients will truly benefit
Another legitimate concern of family physicians is ensuring that the patient will truly benefit from bariatric surgery and will change their lifestyle for the better. Our practice and the industry as a whole have taken great pains to ensure that this is the case. Work ups on the road bariatric surgery are some of the most intense of any major surgical procedure. Most patients undergo cardiac function tests, psychological evaluations, medical weight loss programs and more. The path to surgery can take anywhere from 3 to 6 months. Further, aftercare is a critical part of the bariatric lifestyle and we support our patients long after the surgery is complete. The support helps ensure that patients lose optimal weight, but also identifies any problems before they become severe.
Lastly, there are many primary care physicians who may believe that bariatric surgery is an easy way out, but nothing could be further from the truth. Bariatric surgery offers the metabolic, restrictive and sometimes malabsorptive help the patient needs to jumpstart their weight loss. However, they are ultimately responsible for changing their lifestyle including diet and exercise. They must sustain their weight loss until they reach their goals and then maintain their weight over the long-term. This requires a great deal of dedication to their health and is most definitely not a cop out
So, what can be done? The key to making long-term weight loss more available to qualifying patients is to help them understand why bariatric surgery may be the right option. Having them learn more about bariatric surgery by doing their research online or watching our online seminar is a great first step. Also, understanding the research behind bariatric surgery and the improvements or resolutions of the comorbidities associated with obesity, are quite stunning.
Having patients attend an in-person consultation can also offer them a great deal of insight. All of us here at the practice are dedicated to ensuring our patients are appropriate for a major surgical procedure. We objectively evaluate them for the risks of surgery when compared to the benefits they will receive, and we speak to them very candidly about any nonsurgical options that they may not have tried before. Ultimately, our patient’s success is ours as well and we do everything possible to make sure patients are a) suitable for surgery and b) able to maintain their new and improved lifestyle long into the future.
We encourage any primary care physicians wanting to learn more about bariatric surgery to contact us. We routinely hold webinars to educate our referring physician partners on the latest news, data and information. This information is often very valuable in starting the discussion with patients about how they can appropriately manage their disease.