It‘s important when we see a patient with obesity that we document his or her body mass index (BMI) and outline an optimal therapeutic plan. If we lack the resources, time, or knowledge to carry out this therapy, consider referring the patient to a weight loss–lifestyle intervention program. For patients with morbid obesity who have not been successful following a lifestyle intervention program (hopefully including weight loss medications), the possibility of undergoing bariatric surgery should be seriously considered.
Referral and Surgery Questions
Following are answers to the questions primary care physicians most often ask about obesity referrals and surgery:
• When should I refer a patient with obesity to an endocrinologist?
Obesity therapy should be interdisciplinary. Issues related to nutrition; physical activity; appetite; quality of sleep; and anxiety, depression, and stress need to be addressed. In addition, patients with obesity usually have associated medical problems, such as diabetes, hypertension, hyperlipidemia, and metabolic syndrome, that also require attention.
It is difficult for a single provider to address all these issues during a single visit. Collaboration with other colleagues—nutritionists, physical therapists, psychologists, and endocrinologists—is advised.
• How can I help my patients become more physically active?
Insurance companies do not usually cover a consult with an exercise physiologist, but many patients have osteoarthritis and metabolic syndrome, with an increased risk of heart disease. Physical therapy can be very helpful in providing patients with the right tools to increase their physical activity. Given these circumstances, a consult with a physical therapist should be considered. When patients are at increased cardiometabolic risk, an evaluation by an exercise physiologist in cardiac rehabilitation may be very helpful.