Cardiovascular Kidney Metabolic Toolkit Obesity

Overview

Infographic: Why Obesity Matters. Obesity affects 1 billion+ people worldwide and 37.4% of Wisconsin adults (2024). It raises risk of heart disease, diabetes, and other conditions. Weight stigma limits treatment access, while patient-centered care improves outcomes. — ^{Source: See Diabetes Resources (References 1, 2, 4, 5)}

Weight Bias and Patient Communication

Use Person-First Language: language that recognizes theindividual before the disease:
- Person with obesity
- Obese person

Weight bias can:

Reduce patient trust
Delay care seeking
Decrease engagement in treatment
Negatively impact quality of life

Starting the Conversation

Ask permission before discussion weight

Examples:

"Would it be okay if we talked about how weight may be affecting your health?"
"Are you intererested in discussing strategies that may improve your overall health and weight-related conditions?"

Motivational Interviewing

Motivational interviewing can help:

Explore readiness for change
Identify patient-centered goals
Increase engagement and adherence
Support long-term behavior change

Resources

_{Source: See Obesity Resources (References 5-7)}

Treatment

Lifestyle Interventions

1. Nutrition: No single eating pattern is superior for every patient.

Focus on:

Calorie reduction when appropriate
Nutrient-dense foods
Sustainable eating patterns
Individualized plans based on patient preferences and health conditions

Resources

2. Sleep: Poor sleep contributes to increased hunger, reduced satiety, weight gain, and cardiometabolic disease risk

Providers should routinely assess:

Sleep duration
Sleep quality
Obstructive sleep apnea risk

Resources

3. Physical Activity: Provides substantial health benefits, even when weight loss is modest.

Benefits include:

Improved cardiovascular health
Improved glucose regulation
Better mental health
Preservation of lean muscle mass
Weight maintenance after weight loss

Resources

Obesity Myths and Facts

Myth: Obesity is caused solely by lack of willpower.

Fact: Obesity is a chronic, multifactorial disease influenced by genetics, biology, environment, social determinants of health, and behavior.

Myth: BMI tells the whole story.

Fact: BMI is a screening tool but does not directly measure body composition or health risk.

Myth: Exercise alone causes significant weight loss.

Fact: Exercise supports overall health and long-term weight maintenance but often results in modest weight loss by itself.

Myth: Smaller, more frequent meals are always better.

Fact: Meal timing and frequency should be individualized based on patient preferences and adherence.

Myth: Bariatric surgery is the "easy way out."

Fact: Bariatric surgery is the most effective long-term obesity treatment available and requires substantial preparation and lifelong follow-up.

Myth: Obesity medications are a shortcut.

Fact: Anti-obesity medications are evidence-based treatments for a chronic disease and should be used alongside lifestyle interventions when appropriate.

_{Source: See Obesity Resources (References 8, 16-18)}

Pharmacotherapy

When to Consider Anti-Obesity Medication

Consider treatment for:

BMI ≥30 kg/m²
BMI ≥27 kg/m² with a weight-related comorbidity

Examples of comorbidities:

Type 2 diabetes
Hypertension
Dyslipidemia
Obstructive sleep apnea

FDA-Approved Medications

Semaglutide (Wegovy)
Tirzepatide (Zepbound)
Liraglutide (Saxenda)
Naltrexone/Bupropion (Contrave)
Phentermine/Topiramate (Qsymia)
Orlistat

Clinical Considerations

Review contraindications
Assess pregnancy risk
Discuss expected benefits and side effects
Discuss likelihood of weight regain after discontinuation
Evaluate response after approximately 3 months at therapeutic dose
Continue treatment when effective and tolerated

Resources

ADA Starting FDA-Approved Weight Management Medications (2024)

Procedural and Surgical Treatment

Endoscopic Options
- Endoscopic Sleeve Gastroplasty
- Intragastric Balloon
Bariatric Surgery: Remains the most effective and durable treatment for severe obesity
Benefits include:
- Significant weight loss
- Improvement in diabetes
- Improvement in HTN
- Improvement in OSA
- Reduced cardiovascular risk

_{Source: See Obesity Resources (References 3, 9-12)}

Clinical Operations

Documentation and Coding: Document obesity and weight-related comorbidities whenever appropriate.

Common obesity-related conditions:

Hypertension
Dyslipidemia
Type 2 diabetes
Coronary artery disease
NAFLD
CKD
PCOS
Osteoarthritis
Obstructive sleep apnea
Mood disorders
Eating disorders

Coding

E66.9 Unspecified Obesity
Class I, II, or III obesity designation when appropriate

_{Source: See Obesity Resources (References 13, 14)}

When to Refer

Screening for Secondary Causes

Endocrinology: routine endocrine screening is not recommended unless symptoms suggest an underlying condition.

Consider evaluation for

Hypothyroidism
Cushing syndrome
Acromegaly

Mental Health Provider:

Unaddressed depression, anxiety, or other mood disorder
Eating disorder
Trauma

_{Source: See Obesity Resources (References 19)}‍

Creating an Obesity-Friendly Practice Environment

Ensure equipment safely accommodates patients of all sizes.

Consider:

Bariatric exam tables
High-capacity scales
Appropriate blood pressure cuffs
Bariatric wheelchairs
Patient lifts
Imaging equipment capacity
Appropriate seating and furnishings

Goal: Provide safe, accessible, and respectful care for all patients.

_{Source: See Obesity Resources (References 13, 14)}‍

Patient Resources

Weight Management

Nutrition

Sleep

Physical Activity

_{Obesity Toolkit References}

Back to Cardiovascular Kidney Metabolic Toolkit

Obesity

Overview

Weight Bias and Patient Communication

Resources

Treatment

Lifestyle Interventions

Obesity Myths and Facts

Myth: Obesity is caused solely by lack of willpower.

Myth: BMI tells the whole story.

Myth: Exercise alone causes significant weight loss.

Myth: Smaller, more frequent meals are always better.

Myth: Bariatric surgery is the "easy way out."

Myth: Obesity medications are a shortcut.

Pharmacotherapy

When to Consider Anti-Obesity Medication

FDA-Approved Medications

Clinical Considerations

Procedural and Surgical Treatment

Clinical Operations

Coding

When to Refer

Creating an Obesity-Friendly Practice Environment

Patient Resources

Weight Management

Nutrition

Sleep

Physical Activity

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