W8MD Bariatric Medicine Practice Guidelines
W8MD affiliated physicians use evidence base medicine with thorough understating of obesity and over 50 of its associated conditions. Adapted based on ASBP guidelines, our practice guidelines use the latest evidence in medical research. As bariatric medicine experts, we understand the complex hormonal and metabolic effects of obesity, specifically insulin resistance which plays a key role in increasing the risk associated with obesity.
A. Initial Patient Work-Up
The course of treatment will be based on the patient’s history, physical examination, laboratory work and ECG (when indicated). The focus of the practice will be extensive education on the effects of metabolic syndrome, insulin resistance, inflammation, with counseling on behavior modification and nutrition. If these tests were performed recently by other health care providers, we can work with you to obtain copies of these tests that might have been ordered by their primary care providers such as lipid profiles, TSH, EKG etc. to the extent possible. We also intend to involve the patient’s other care givers, especially the primary care provider, in the long term management of the patients obesity associated conditions such as lipid management, hypothyroidism etc. The practice will focus on Behavior therapy, nutrition counseling, eating disorder management, and meal replacement plans.
A history of each patient will be taken and recorded. It will include an evaluation of dietary status, a weight history and a history of mental status. Whenever this is a self-fill-in, or computerized history, or one taken by assistants, our physicians will personally evaluate significant positive responses and make appropriate notations.
2. Physical Examination
The physical examination will include the following:
a. Height, weight, blood pressure and pulse.
b. Additional examinations will be done which are appropriate for the patient’s age and state of health. Usually this would include examinations of the head, neck, thyroid, heart, lungs, abdomen and extremities. The patient’s records will indicate the status of observations made.
3. Diagnostic Studies
a. Laboratory Work: An “executive-type” profile including testing for thyroid function (TSH suggested), liver, kidney function, lipid profile, fasting blood sugar, uric acid, urinalysis, HgA1c etc. will be completed in addition to other laboratory work if indicated. If these tests were ordered recently by other providers, a copy will be requested.
b. Electrocardiogram: Required if there is reasonable evidence of present or past significant cardiac
disease. In addition, the potential value of an ECG will be considered if coronary heart risk factors are present; e.g., hypertension, hyperglycemia, dyslipidemias or a strong family history of cardiac
c. Optional Tests: Body composition using skinfolds, infrared or impedance testing may be performed as additional testing. Other tests may be included at the discretion of our physicians/physician extenders.
4. Patient Counseling
Appropriate counseling will be given to patients on proper eating habits, exercise, behavior modification, medications and other aspects of therapy, prior to and during the weight loss program. When prior medical records can be obtained indicating any of the above procedures have recently been completed, our physicians will try to avoid unnecessary duplication by performing only those exams needed to complete the bariatric work-up.
5. Return Visits
Our physicians will provide adequate periodic follow-up and counseling for the patient.
B. Medications and Other Therapeutic Modalities
1. Our bariatric medicine physicians will weigh the potential benefits and risks of any medication or modality used. Significant sources of such information include journal articles, experience of colleagues, labeling, textbooks, The ASBP Anorectic Usage Guidelines, and personal education, training and experience. Each of these sources may provide valuable information, and no single source will be used to the exclusion of others.
2. When appropriate, the bariatrician will provide information on the benefits and risks of the proposed treatment modalities to be used and will inquire as to the patient’s understanding of the benefits and risks.
3. When medications are dispensed, they will be packaged and labeled in accordance with applicable laws and appropriate records will be kept.
A program, as developed by Dr Tumpati, will be provided for helping the patient in maintaining the weight loss that has been achieved.
D. Meal Replacements
A meal replacement program that aims to limit the choices to the patients and provide a balanced low calorie, low carbohydrate diet will be made available to the patients that might be interested in these products.