Treating Obesity in Primary Care

Preface
Contents
Author Bio
Introduction
	References
Part I: Understanding the Disease
	Chapter 1: Bias and Stigma Related to Patients with Obesity
		Introduction
		Bias
		Barriers
			Most Common Barriers from the Provider: Time, Billing, Education
		Office Issues
		References
	Chapter 2: Obesity as a Disease
		Introduction
		So Is Obesity Really a Serious Chronic Disease?
			Definition of a Chronic Disease
			Obesity as a Chronic Disease
		Why Do We Care if Obesity Is a Disease?
		Does Obesity Need to Be Treated?
			Diagnosis
			Staging Obesity
		Is It Even Important to Make a Diagnosis or Can Just Treating the Complications Be Enough?
		References
	Chapter 3: Physiology of Adipose Tissue
		Introduction
		Central Nervous System Control of Eating
		Physiology of Adipose Tissue
		Future Use of Adipose Cells
		Hormones
			Leptin
			Insulin
			CCK
			Adiponectin/Resistin
			Ghrelin
			GLP-1
		Summary
		References
	Chapter 4: Pathophysiology of Obesity
		Introduction
		Adiposity and Defense of Increased Adiposity
		Brain Disease
		Endocrine Disease
		Infectious Etiology
		Genetic Factor
		Inflammation
		Endocrine-Disrupting Chemicals
		Microbiome
		Inflammation
		Behavior
		Smoking Cessation
		Weight Regain
			So What Is Metabolic Adaptation?
			Are There Any Benefits Even with Weight Regain?
			Clinical Practice Implication
		Conclusion
		References
	Chapter 5: Obesity-Related Complications
		Introduction
		All-Cause Mortality
		Cancer
			Mechanism
			Clinical Implications
		Liver
			Mechanisms
			Clinical Implications
		Kidneys
			ORG
			Mechanism
			Clinical Implications
		Chronic Kidney Disease
			Mechanism
			Clinical Mechanism
		Metabolic
			Mechanism
		Prediabetes
			Mechanism
		Diabetes
			Mechanism
			Clinical Implication
		Metabolic Syndrome
			Mechanism
			Clinical Indications
		Cardiovascular
			Mechanism
			Clinical Implications
		Atrial Fibrillation (Afib)
			Mechanism
			Clinical Implications
		Heart Failure
			Clinical Implications
		Dyslipidemia
			Mechanism
			Clinical Implications
		Hypertension
			Mechanism
			Clinical Implications
		Polycystic Ovary Syndrome (PCOS) and Female Infertility
			Mechanism
			Clinical Implications
		Male Hypogonadism
			Clinical Implications
		Conclusion
		References
Part II: Building a Treatment Plan
	Introduction to Part Two
	Reference
	Chapter 6: Chronic Disease Model for Obesity
		Introduction
		Chronic Care Model
		References
	Chapter 7: Evidence-Based Guidelines for the Treatment of Obesity
		Introduction
		Guidelines and Eating
		Guidelines and Physical Activity
		Guidelines and Medications
		Summary
		References
	Chapter 8: Foundational Component of Treating Obesity: Eating Plans
		Introduction
		Energy Balance Versus Quality Aka Quantity Versus Quality
		Eating Plans
		Assessment
		Eating Plans and Patterns
			Macronutrient
				Low Fat
				Low Carbohydrate
			Meal Plans
				Mediterranean
				Whole Foods Plant Based (WFPB)
			Meal Patterning
				Fasting
				Energy Focused
				Which Plan for Whom?
		Miscellaneous Issues
			Fruits and Vegetables
			Caloric Beverage
			Fast Food
			Protein at Breakfast
			National Weight Control Registry
		Angies’s Process of Guiding Patients
		References
	Chapter 9: Foundational Component of Treating Obesity: Physical Activity
		Introduction
		Energy Expenditure
		Activity and Guidelines
			Physical Activity and Aerobic Exercise
			Resistance Training
			Writing a Prescription for Physical Activity
		References
	Chapter 10: Foundational Component of Obesity Treatment: Behavioral Intervention
		Introduction
		What Is Behavioral Intervention?
		Research for ILI and IBT
			How Often Should Behavior Interventions Occur?
			Does Delivery Method Matter?
		Methods for ILI
			5 As and SMART Goals
			Goal Setting
			Mindfulness
			Tracking
		Readily Available Educational Resources
		Problem-Solving and Goal Setting
		References
	Chapter 11: Supportive Component of Treatment: Medications for Treating Obesity
		Introduction
		Barriers
		Anti-Obesity Medications (AOMS)
			Expectation
			Who Should Be Considered for Anti-Obesity Medications?
			General Considerations and Pharmacologic Initiation
			What Are the Approved Agents Today?
		Short-Term Anti-Obesity Medications
		Long-Term Anti-Obesity Medications
		Choosing Which Medication to Start with
		Making a Switch
		Other Medications
		History of Weight Loss and Anti-Obesity Medications
		What Not to Use
		Future
		References
	Chapter 12: Supportive Component of Treatment: Procedures and Surgery
		Introduction
			How Bariatric Surgery Works
			Surgery
			Devices
				Intragastic Balloons
				Aspiration Therapy
				Endoscopic Sleeve Gastroplasty
				Vagal Blocking
				Hydrogel Matrix
			Primary Care Role
				Lifetime Monitoring Post-Surgery
		References
Part III: Putting It All Together in Clinic
	Chapter 13: Billing for Obesity Treatment
		Introduction
		Added Complexity
		Preventative Coding
		Counseling Codes
		Codes Specific to Obesity
			Medicare and Obesity
		General Documentation
			Documentation and Billing Examples
			Preventive Counseling Coding and Documentation
			Preventive (Example of Assessment/Plan and Billing for the Visit)
			Follow-Up Visit for Joe
			MEDICARE IBT Documentation and Coding (Example of FU IBT)
		References
	Chapter 14: Putting It All Together in the Treatment of Obesity in Primary Care
		Introduction
		Preparation
			Visit Zero
		*Ask
		Visit One for Obesity
			Assess
			Physical Examination (Table 14.1)
				Vital Signs
			Screening Tools
			Diagnostics (to Assess for ORCs or Complications)
			Diagnose and Stage
			Plan
			Visit Two—Initiating Obesity Treatment Plan
			Visit Three
			Visit Four
			Visit Five
			Visit Six On Continues in the Same Way
		Practice Profiles
			Primary Care Integration
			Dedicated Day(s) for Obesity
	Chapter 15: Example in Clinic
		Introduction
		Ashley
			Visit One for Obesity
				Patient History
				Social History
				Physical Exam
			Chart Note
				Diagnose and Stage
			Visit 2–22
		Susan
			Visit One for Obesity
				Patient History
				Social History
				Physical Exam
			Chart Note
				Diagnose and Stage
		John
			Visit One for Obesity
				Patient History
				Social History
				Physical Exam
			Chart Note
				Diagnosis and Stage
Conclusion
	Resources
Index