ASBP Releases Obesity Treatment Algorithm
An obesity algorithm released by the American Society of Bariatric Physicians (ASBP) is designed to help navigate a physician's role in medically treating and caring for patients affected by obesity. The overall emphasis of the algorithm is to improve patients' overall health and reduce the risk of developing associated conditions, such as type 2 diabetes, hypertension, sleep apnea, cardiovascular disease, and depression.
Given the American Medical Association's decision in June 2013 to declare obesity a chronic disease state, more patients are seeking treatment options from their primary care providers. "Physicians are now confronted with the need to understand what makes obesity a disease and how patients affected by obesity are best managed," said ASBP President-elect and Algorithm Committee Co-chair Deborah Bade Horn, DO, MPH.
Following a review of the patient's current lifestyle, medical history, physical exam, and laboratory testing, physicians can use the algorithm to help determine whether these results warrant initiation of obesity treatment and/or referral to a specialist. Notably, the algorithm focuses on identifying the presence of diseases, which can be a direct result of fat mass disease and/or "sick fat disease" (adiposopathy), which is important in understanding how a patient's excess fat or dysfunctional fat may be impacting his/her health. This is a significant departure from other guidelines and algorithms, which tend to focus primarily on addressing body weight, according to the authors.
The algorithm stresses early intervention in order to prevent and reverse disease and the importance of ongoing physician support for patients to achieve and maintain success.
The algorithm "encompasses all aspects of adiposity; is very structured and addresses all concepts, from BMI to percentage of body fat and its meaning," commented Grazia Aleppo, MD, FACE, FACP, Associate Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine at Northwestern University in Chicago. "In addition, clinicians are now encouraged to utilize diagnostic tools previously only used by dietitians. This algorithm reviews their significance in patient evaluation" she said.
Individualized Treatment Strategies
The algorithm provides training and tools for prescribing and implementing individualized obesity treatment plans including the following:
- Diet: caloric or carbohydrate restriction, food journaling, very low calorie diet
- Exercise: exercise prescription, use of pedometers, limiting TV and computer time, goal of a minimum of 150 minutes/week of moderate intensity physical activity
- Counseling: eliminate provider bias/stigma, identify self-sabotage, develop strong support, stress management, sleep optimization, and other psychological support
- Use medications as part of a comprehensive program
Referral to a metabolic and bariatric surgeon may be necessary if other less invasive treatments are ineffective. Furthermore, the algorithm offers suggestions on ways to explain diagnostic criteria, risk assessment, and treatment decisions with patients.
"This will help give physicians a better opportunity to manage patients affected by obesity in the most compassionate, scientifically sound and cost-effective way possible," said ASBP Trustee and Algorithm Committee Co-chair Jennifer Seger, MD.
Practical Application of the Algorithm
"The algorithm is very easy to use and is visually easy to follow; it is an educational tool that can be used not only for physician education, but also to instruct the many patients in the primary care setting who are struggling with obesity," Dr. Aleppo said. "The sections are clearly defined and although I recommend that the clinicians take the time to read the entire document, it has specific sections that address treatments in great detail, including side effects and contraindications," she said.
"The algorithm describes the many steps to effectively treat obesity, from therapeutic lifestyle changes, focusing on education and behavior modification, to pharmacologic therapy and/or surgical interventions," Dr. Aleppo noted. In addition, she said, "the busy clinician can definitely use this as a reference both for personal review and with patients to show the effects of untreated and worsening adiposity and, ultimately, of obesity."
"Any patient, including patients with diabetes, can benefit from the early interventions suggested in this algorithm," Dr. Aleppo said. "It is important to mention, however, that the obese patient with diabetes will benefit from the recommendations in this algorithm only when supported or preceded by diabetes education, which enables the patients to understand their disease, thus empowering them to take control of their health from multiple perspectives," she said.
The ASBP Obesity Algorithm and a video podcast on how to implement the algorithm are available at www.ObesityAlgorithm.org.