#Obesity - BMI ***
-- Explore the patient’s history with their weight - are they interested in discussing it further, what have they tried in the past that has and has not worked, do they have any current goals, etc.
-- Review med list - are there any medications associated with weight gain that can be changed out?
-- Calculate daily caloric requirement - link
-- Exercise and Activity - assess fitness level, set SMART goals, start low and progress slowly, warm up, listen to your body, build activity into daily routine, allow time for recovery, put it on paper and track progress
-- Weight Loss Goal: *** in general can start with 5-7% body weight; within ***
-- Exercise and Activity Goal: *** activity logs; >30 mins activity 5 days per week is goal, can start with standing/walking with TV, using stairs
-- Diet : food diaries, limit sugary drinks/added sugars, refined carbs; drink more water; eat more protein, vegetables, fiber; utilize smaller plates; restrict the time you eat
-- Medications: *** if BMI >30 or 27-29.9 with weight-related comorbidities and have not lost at least 5% TBW after 3-6 months life changes; liraglutide/semaglutide/tirzepatide, orlistat, phentermine-topiramate, naltrexone-bupropion
Bariatric referral: *** if BMI >40 or BMI >35 and obesity-related complications despite weight loss attempts
Template coming soon!
Clinically meaningful weight loss is 5-10% of total body weight. BMI is an imperfect measurement, but in general the goal for most patients should be <25. A thorough intake includes exploring the patient's history with their weight, what they have tried in the past, and whether they have any goals for their weight. While caloric restriction has historically been the mainstay of diet approaches, many other factors can contribute including age, height, sex, bone density, muscle-fat ratio, genetics, and the food itself. Lifestyle changes include diet (low carbs/artificial sugars, rich in vegetables, intermittent fasting), and exercise (goal >30min 5 times per week, combo of aerobic and resistance training). The focus of pharmacologic management has shifted recently towards GLP-1 agonists and should be considered when BMI >30 or BMI 27-29.9 with weight-related co-morbidities and the patient has had trouble losing at least 5% of their total body weight after 3-6 months of comprehensive lifestyle changes. Bariatric surgery may be an option for patients with BMI >40 or >35 with obesity-related compliations remediable by weight loss.
Medications associated with weight gain