#405 Obesity Medicine, GLP1 agonists, Weight Loss Management Tools and Tips
TLDRIn this Curbsiders podcast episode, Dr. Matthew Watto and Dr. Paul Nelson Williams discuss obesity medicine with Dr. Kim Gajuni, an expert in the field. They delve into the challenges of treating obesity, the importance of addressing weight loss with patients, and the role of various anti-obesity medications. Dr. Gajuni emphasizes the need for a comprehensive, team-based approach to obesity care, highlighting the value of nutrition, psychological support, and the use of telemedicine. The conversation also touches on patient experiences with weight loss medications, the significance of maintaining muscle mass during weight loss, and strategies for managing side effects.
Takeaways
- 🎉 Joining the Curbsiders Patreon can enhance the listening experience with ad-free episodes and bonus content.
- 📱 The Curbsiders podcast is a great way to use CME money and support the show for continued valuable content.
- 👩⚕️ Dr. Kim Gajuni is an expert in obesity medicine and has a unique perspective on the healthcare experience and weight management interventions.
- 🏠 Hobbies outside of medicine, such as home renovation, can provide a creative outlet and stress relief.
- 🚗 Embracing failure, like navigating through a new city, can lead to unexpected adventures and learning experiences.
- 🏥 Primary care doctors may face barriers in treating obesity due to lack of education and training in medical school.
- 🤝 Building a team with diverse expertise, such as hepatologists, endocrinologists, and psychologists, can improve obesity treatment outcomes.
- 💊 Anti-obesity medications should be discussed thoroughly with patients, including mechanism of action, side effects, and cost considerations.
- 🥗 Telemedicine has revolutionized obesity medicine by increasing accessibility and frequency of contact without the need for in-person visits.
- 🏋️♀️ Incorporating resistance training and mindful eating can help preserve muscle mass and improve weight loss outcomes.
Q & A
What is the main topic of discussion in the Curbsiders podcast episode featuring Dr. Kim Gajuni?
-The main topic of discussion in the Curbsiders podcast episode is obesity medicine, including counseling, medication, and the overall approach to treating obesity as a chronic disease.
What is Dr. Kim Gajuni's professional background and role in obesity medicine?
-Dr. Kim Gajuni is an internal medicine and obesity medicine physician, serving as the medical director of the American Board of Obesity Medicine and an associate professor of medicine at Johns Hopkins. She founded and directs the Johns Hopkins Healthful Eating Activity and Weight program, with research focusing on obesity's influence on healthcare experiences and health disparities.
What is a common barrier primary care doctors face when discussing obesity and weight loss with patients?
-A common barrier primary care doctors face is a lack of education and training on obesity treatment, leading to difficulty in knowing where to start and how to synthesize the overwhelming body of information available on the subject.
How does Dr. Gajuni suggest starting a conversation about weight with patients?
-Dr. Gajuni suggests asking patients for permission to discuss their weight, giving them the power to decide if they want to talk about it or not, and using this approach to open the doorway for further conversations.
What is the significance of using a diagnosis code for obesity in patient records?
-Using a diagnosis code for obesity in patient records is important for tracking the prevalence of the condition, informing employers about the needs of their employee population, and ensuring appropriate insurance coverage and benefits for obesity treatment.
How does the concept of a 'set point' relate to weight regulation and obesity treatment?
-The 'set point' refers to the body's natural tendency to maintain a certain weight, and when someone loses weight, their body may work to return to this set point by slowing metabolism and increasing hunger, making long-term weight management challenging.
What is the role of motivational interviewing in obesity treatment?
-Motivational interviewing can be a useful tool for primary care providers when dealing with patients who have ambivalence towards change. It helps in understanding the patient's motivation and barriers, but its efficacy in behavioral weight loss programs may not be superior to other approaches.
How does telemedicine impact long-term weight management?
-Telemedicine has revolutionized obesity medicine by increasing accessibility to providers without the need for in-person visits. It allows for more frequent contact, which is crucial for weight management, and has been shown to be effective for counseling and shared decision-making.
What are some resources or tools Dr. Gajuni recommends for patients to aid in their weight management journey?
-Dr. Gajuni recommends resources like the USDA for nutritional information, meal planning websites such as eatingwell.com, and tracking apps for accountability and mindfulness. She also emphasizes the importance of working with dietitians and psychologists specialized in eating behaviors and cognitive-behavioral therapy.
What is the significance of addressing metabolic endpoints in obesity treatment, rather than just focusing on absolute weight numbers?
-Addressing metabolic endpoints, such as pre-hypertension, pre-diabetes, and fatty liver disease, helps to focus on the overall health risks and the prevention of progression to more severe conditions. It also considers the patient's functional limitations and psychological impacts, making the treatment goal more relatable and motivating.
Outlines
🎉 Introduction and Patreon Promotion
The video begins with a host promoting the Curbsiders Patreon, highlighting the benefits of annual memberships, ad-free episodes, and bonus content. The host, Dr. Matthew Watto, introduces his co-host, Dr. Paul Nelson Williams, and they discuss their experiences and the show's focus on clinical pearls and practice-changing knowledge through expert interviews. The episode features Dr. Kim Gajuni, an obesity medicine specialist, and the hosts emphasize the importance of supporting the show for continued high-quality content.
🤝 Welcoming Guests and Discussing Obesity Medicine
Dr. Kim Gajuni is welcomed to the show, and she shares her background in internal medicine and obesity medicine. The discussion delves into the multifaceted approach to obesity medicine, including counseling, medication, and understanding the impact of obesity on healthcare experiences. Dr. Gajuni's research interests and her role in advancing obesity medicine are highlighted, and the hosts express their appreciation for her contributions to the field.
🏠 Personal Life and Renovation Experiences
The conversation shifts to personal experiences, with Dr. Gajuni sharing her hobby of home renovation, inspired by HGTV. She talks about the challenges and rewards of fixing up a house, including dealing with deferred maintenance. The hosts and Dr. Gajuni bond over their shared experiences with home renovations and the joy of transforming spaces.
🚗 Reflecting on Personal Failures and Lessons Learned
Dr. Gajuni shares a personal story of renting a car in Rome, which led to getting lost and encounters with frustrated locals. Despite the stress, she reflects on how the experience turned into an adventure and taught her that not knowing where you're going can lead to unexpected fun. The hosts relate to her story, discussing how failures can be valuable learning experiences.
🏥 Barriers in Primary Care Obesity Treatment
The discussion returns to professional topics, focusing on the challenges primary care doctors face when addressing obesity. Dr. Gajuni discusses the lack of education on obesity treatment and the overwhelming nature of synthesizing information for patient advice. The conversation touches on the importance of starting somewhere, the stigma around discussing weight, and the need for better training and awareness in obesity care.
💊 Medication Management and Patient Conversations
The hosts and Dr. Gajuni discuss the approach to medication management in obesity treatment. They cover the importance of normalizing weight loss plateaus, discussing all available anti-obesity medications, and tailoring treatment to individual patient needs. The conversation emphasizes the need for shared decision-making, managing side effects, and considering cost and insurance coverage.
🥗 Nutritional Counseling and Tracking
The discussion shifts to nutritional counseling, with Dr. Gajuni emphasizing the balance between nutritional advice and cost efficiency. She mentions the use of dietitians for advanced cases and the reliance on training in nutrition for general counseling. The hosts and Dr. Gajuni also discuss the role of tracking apps, focusing on accountability and mindfulness rather than precise nutritional balances.
🧠 Addressing Emotional Eating and Psychological Support
Dr. Gajuni highlights the importance of psychological support in obesity treatment, particularly for patients with emotional eating tendencies. She discusses the role of psychologists trained in eating disorders and the benefits of cognitive behavioral therapy. The conversation touches on the need for contingency planning and the potential use of screening tools to identify patients who may benefit from psychological support.
💊 Continuation of Medication Discussion and Patient Management
The conversation continues with a focus on medication management for weight loss. The hosts and Dr. Gajuni discuss various FDA-approved medications, their mechanisms of action, side effects, and the importance of titration to effect. The discussion also covers the management of side effects, the balance between weight loss and maintaining lean mass, and the role of protein and fiber in diet.
📚 Final Thoughts and Resources for Practitioners
In the concluding segment, Dr. Gajuni shares key takeaways for practitioners, emphasizing the importance of initiating conversations about weight loss with patients and seeking partnerships with dietitians and psychologists. She encourages a team-based approach to obesity medicine and shares resources for nutritional guidance and tracking apps. The hosts thank Dr. Gajuni for her insights and discuss the value of the show in promoting high-value practice-changing knowledge.
Mindmap
Keywords
💡Curbsiders
💡Patreon
💡Obesity Medicine
💡BMI
💡Weight Management
💡Primary Care
💡CME
💡Pharmacotherapy
💡Health Disparities
💡Weight Bias
Highlights
Curbsiders podcast offers an annual membership on Patreon with a 10% discount on the monthly rate.
The podcast focuses on clinical pearls and practice-changing knowledge in internal medicine.
Dr. Kim Gajuni, an obesity medicine physician, shares insights on obesity's impact on healthcare experiences and weight management interventions.
The show discusses the challenges primary care doctors face when addressing obesity and weight loss with patients.
Lack of education and training in obesity treatment is a significant barrier for primary care physicians.
Weight bias and stigma can create a reluctance for both physicians and patients to discuss weight loss openly.
The podcast emphasizes the importance of beginning the conversation about weight by asking patients for permission.
Discussing obesity as a chronic disease helps normalize the condition and reduces shame.
The podcast highlights the need for primary care providers to educate themselves on obesity treatment to better support their patients.
Telemedicine has revolutionized obesity medicine by increasing accessibility and frequency of contact between patients and providers.
The Helpful Eating Activity and Weight Program brings together various healthcare providers for collaborative obesity treatment.
Addressing obesity involves understanding the physiology of weight regulation and the body's hormonal responses.
Patients with obesity often internalize weight bias, leading to self-blame and a perception of personal failure.
The podcast stresses the importance of a team approach in obesity medicine, including dietitians, psychologists, and other specialists.
Medication therapy for weight loss is a topic of interest for many patients, and a variety of FDA-approved options are available.
GLP-1 agonists are popular for weight loss, but it's crucial to monitor for side effects and adjust dosages to avoid excessive appetite suppression.
Patients on weight loss medication should be counseled on the importance of maintaining a balanced diet with adequate protein and fiber intake.
The podcast concludes with advice for primary care providers to normalize conversations about weight, collaborate with other healthcare professionals, and continue educating themselves on obesity treatment.
Transcripts
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