Nurse Practitioners Exploring Obesity Treatments in Endocrinology
Learn how to pair the latest advances in obesity treatment with patient-centered care and attention to combatting bias.
Caring for patients with obesity is an evergreen concern for many health care professionals, and nurse practitioners (NPs) — working in the realm of holistic, whole-person care — can choose from a number of options to reinforce the primary goal of helping an individual live a healthier life. To help patients, NPs can simultaneously consider diet, exercise, medication and even surgery.
On the latest episode of NP Pulse: The Voice of the Nurse Practitioner®, Shannon Idzik, DNP, ANP-BC, FAANP, FAAN, co-chair of the American Association of Nurse Practitioners® (AANP) Endocrine Community, speaks with Sara Rose MacLeod, DO, MPH, about “The Science and Strategy of Obesity Management.” They discuss advances in obesity treatment and share some of the wisdom they’ve gained from speaking with patients and individualizing their approach to best address each unique patients’ needs.
Why Is Speaking About Obesity So Crucial?
To help underscore their discussion about treating obesity, Idzik says: “To orient our listeners, we know obesity is common. In fact, it’s the most common chronic disease in our country.” She provides further context, explaining that “800 million people worldwide have obesity, which is 42% of the United States…It is the most prevalent chronic disease in our country.” Aside from the risks obesity poses to an individual, it is also a costly disease, with the U.S alone spending “$173 billion” on obesity per year. As Idzik concludes: “That’s just an unsustainable amount of cost related to one chronic condition.”
Because of the stigma and bias that can surround obesity, NPs need to have a strong bond of trust with a patient before prescribing lifestyle changes. After Idzik discusses how obesity bias can negatively impact a patient, she suggests instead to “really use person-centered, nonjudgemental conversations with patients and collaborate with them, like you would any other condition. Ask them, ‘Can we talk about your weight? Can we talk about these numbers together?’
MacLeod says that sometimes she waits for a patient to bring up their weight, “and then I use that as a get-in-the-door moment and say something like, ‘Oh, you brought up your weight. Would you like to talk more about that today?’ Or, if they don't bring it up, you could say something to the effect of, ‘You know, I noticed your body mass index (BMI) is a little bit higher than what we would consider normal. Would it be okay if we talk about your weight at today's visit?’”
Getting Active and Eating Well
After broaching the subject, NPs can begin to tailor a plan to treat a patient. Taking both genetics and social determinants of health into account, health care professionals can begin by emphasizing the classic combination of diet and exercise. Regarding the former, MacLeod recommends, in part, “the tried and true Mediterranean diet.” This diet “focuses on dark green veggies, nuts, legumes, healthy fish and seafood,” and Idzik agrees that for her, the Mediterranean diet is “probably the most sustainable diet.” That said, she emphasizes a whole-person approach to health, noting that “exercise is a really important part of health and wellness.”
While noting that “physical activity alone really only produces about 1 to 3% weight loss,” exercise also “helps (patients) preserve lean mass, improves overall health and really should be a part of every treatment plan,” says Idzik. At the least, she recommends “30 minutes, 5 days a week” of exercise, “or 75 to 150 minutes vigorously, really working, getting that heart rate and metabolic rate up.” She notes that moderate exercise decreases “visceral adiposity, which puts us at risk for metabolic diseases.” What about patients who are doing absolutely no exercise at all? Idzik shares that in her practice, “the first thing I say to them is to just do something — just walk 10 minutes every day, take the stairs […] ride the bus and walk to your office. Just do something.”
Medication and More
Of course, every discussion about treating patients with obesity must include a discussion about the breakthroughs providers and patients are seeing through the use of what MacLeod calls “novel medications.” Idzik mentions “incretin-based therapies, because I think the GLP-1s really have revolutionized obesity care.” She says that “when I frame GLP-1s for patients, I say to them, ‘The medicine really increases your odds that all of your efforts are actually going to turn into measurable losses.’”
Alongside lifestyle changes in diet and exercise, starting on a GLP-1 “just helps them put that action into work. I do talk to them a lot about these side effects and also about losing muscle mass. And we start them low — they all have a starting dose, and we start on that low starting dose and escalate up on the schedule that we're supposed to. Eating smaller meals, favoring protein, making sure they're getting enough protein in their diet, making sure they're staying hydrated.”
When is surgery an option for a patient with obesity? MacLeod says that in the past, “that classic recommendation was with a BMI greater than or equal to 40, or a BMI greater than or equal to 35 with obesity-related complications. But newer guidelines and recommendations actually have shifted that down, such that now we’re recommending with a BMI of 30 or above in some folks. So, it really depends which guidelines you’re looking at, but I would start considering it with a BMI of 30 or above.”
Idzik and MacLeod discuss much more related to obesity care, and Idzik ends their discussion on a note of optimism: “As we've moved into new treatments for obesity, it's been refreshing as a provider who's cared for patients with obesity and metabolic disease for so long, and feeling like you wanted to work with them to help them in some way and just didn't have the tools…and now I feel like we're getting the tools in our tool chest to really make a difference in people's lives.”
Learn More About Endocrinology and Earn Continuing Education Credit
If you are interested in learning more about endocrinology, enroll in Clinical Advantage: Endocrinology Certificate for Advanced Practice Providers — Part 1, which offers 8.2 contact hours of continuing education credit; 3.25 of which may be applied toward pharmacology. The course is part of The Endocrinology Certificate Program, which equips NPs and physician associates with comprehensive, practice-ready knowledge to assess, diagnose and manage common and complex endocrine conditions.
This activity is supported by independent educational grants from Ascendis Pharma Inc., Novo Nordisk Inc., and Xeris Pharmaceuticals, Inc.