• What about depression, anxiety, and eating disorders?
Depression is prevalent in patients with obesity. Consider a consult to a psychologist to help improve patients’ anxiety-depression. This consult may help them better deal with the stressors in their lives that may be responsible for their overeating. In some circumstances, it may be also important to rule out eating disorders, such as the binge eating of bulimia.
• Is this patient a candidate to undergo bariatric surgery?
To be a candidate for bariatric surgery, a patient needs to have a BMI ≥ 40 kg/m2. The cutoff is > 35 kg/m2 if he or she has associated medical problems, such as hypertension, type 2 diabetes, elevated cholesterol, significant osteoarthritis, obstructive sleep apnea, or gastroesophageal reflux. Secondary causes of obesity, such as hypothyroidism and Cushing disease, should be ruled out.
The patient, his or her family, and the physician need to be convinced that a medically supervised weight loss program has not been successful in helping the patient lose weight and, more importantly, keep the weight off. At that point, bariatric surgery should be seriously discussed. Reviewing with the patient the potential risks, the need to take vitamins long term, and the need to come to follow-up visits is also very important.
Coming soon, the final part of this Special Report on Obesity in Primary Care, a post-test to assess your knowledge of the latest developments in patient care. Watch your email for eNewsletters from Patient Care and visit our homepage at www.patientcareonline.com to check for updates.
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