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Obesity: A Bariatric Surgeon Speaks to Primary Care Physicians

November 2, 2012

Obesity is a chronic disease, and difficult to treat with diet and medication—particularly if the patient is morbidly obese.

Here, David von Rueden, MD, Director of Bariatric Surgery at St. Agnes Hospital in Baltimore offers guidance to primary care clinicians about strategies that can be effective for patients with BMIs of 30 to 35 (a multidisciplinary program that includes nutritional counseling, exercise, and behavioral modification), and for those with BMIs of > 35 (usually bariatric surgery combined with behavioral modification and psychosocial counseling.)

Dr. von Rueden discusses factors that make it difficult for obese patients to lose weight with diet and medication; offers practical guidance about when to broach the subject of weight loss with your patient and what options to suggest; and what your role is after a patient has had bariatric surgery.

by Karen Decker-Brown | December 07, 2012 2:44 PM EST

Having had bariatric surgery over 10 years ago, with a distal anastomoses, I will say there are downsides to having it almost as much as the obesity. Ensure pt knows if proximal, medial, or distal anastamosis as this makes a big difference in absorption of nutrients, calories and medication. Other physicians do not realize that it may take as much as 10 times the amt of medication to reach a therapeutic level that non bariatic pts get with one pill. Where this can get problematic is with scheduled meds. Realize each pt's absorption is different and may be different on different days. Pharmacists too need to be aware of this as it is difficult at times to get them to go above the usual and customary dose. Drawing therapeutic levels helps ensure pt is getting sufficient amts and not overdosing as well as convincing pharmacy. Karen ANP

TOPIC INDEX

Developmental/Genetic

Nutritional/Metabolic

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Obesity: A Bariatric Surgeon Speaks to Primary Care Physicians

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