Multidisciplinary Approach to Obesity Management: A Case Report

Summary

Obesity care is best delivered after in-depth initial screening and evaluation, using an individualized approach comprising multidisciplinary care, evidence-based lifestyle behavioral change strategies, and frequent follow-up. We illustrate a successful 6 month course of weight loss treatment, resulting in reversal of obesity-related chronic conditions and improvement in diet, sleep, mood, and physical fitness.

Abstract

Effective weight management care emphasizes a patient-centered approach that employs evidence-based tools and strategies to address the complex and multifactorial nature of obesity and prevent chronic obesity-related medical conditions. Successful outcomes hinge on personalized care, consistent engagement, and the integration of multiple interventions that are tailored to individual needs and circumstances. In the John Hopkins Healthful Eating, Activity and Weight Program (HEAWP), healthcare professionals specializing in obesity medicine work in partnership with other specialists, including behavioral therapists, dieticians, psychologists, psychiatrists, sleep specialists, bariatric surgeons, gastroenterologists, and physical therapists, while also involving patients in their own care.

Each patient starts with an in-person intake meeting with an obesity physician, during which information about their nutrition, sleep, mood, medications, social support, and physical exercise is evaluated. By the end of the visit, realistic goals are set in concert with the patient, and the patient is given specific tasks to assist them in accomplishing these goals. The initial phase of the intensive evaluation and treatment at HEAWP typically lasts 6 months, with follow-up medical visits every month. At that point, goals are reassessed and future treatment plans formulated. The average pace of weight loss is 1-2 pounds (0.4-0.9 kg) per week.

Introduction

Obesity has become an increasing global epidemic. Defined by the World Health Organization (WHO) as a chronic, multifactorial, and relapsing disease, obesity has reached pandemic proportions, with more than 1 billion people affected at increasing rates in nearly every country in the world^1,2. Obesity is a disease associated with hundreds of medical complications and early deaths. At least 5 million obesity-related deaths occur annually, ~12% of all deaths from noncommunicable diseases globally³. Global costs of obesity are predicted at $3 trillion per year by 2030 and account for up to ....

Protocol

1. Initial evaluation visit at HEAWP

1. Weight history
   1. The physician reviewed current weight and recognized weight trends. The patient reflected on the current trend and on previous successful and unsuccessful weight loss attempts.
2. Past medical history
   1. The physician and the patient reviewed the list of known medical conditions, their year of diagnosis, and their current treatment
3. Obesity-related comorbidities and their severity
   1. Specific obesity-related comorbidities were discussed, including current and past treatment, and their lab values
....

Results

After a year, the patient had lost 66 pounds (30 kg), reducing his weight by 18%, from 361 to 295 pounds (from 164 to 133 kg), and his BMI declined from 44 to 37 kg/m² (see Supplemental Table S1). That reduction in weight helped him control his blood pressure without medications, reverse his prediabetes, improve his fatty liver, and eliminate the pain he had formerly suffered when working out. This weight loss was achieved using a dynamic nutritional plan, a customized exercise plan, improveme.......

Discussion

The past few decades have brought a shift in medicine's approach to obesity and its treatment. Historically, obesity was considered a result of personal choices, such as overconsumption of calories and physical inactivity, and treatment options were limited. It is now clear that obesity is caused by a myriad of causes, spanning behavioral, environmental, and genetic factors that may have resulted in appetite dysregulation, where hormonal and neural mechanisms that regulate hunger and satiety become unbalanced

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Medications
1.      Phentermine-topiramate (Qsymia) 3.75-23 mg	Vivus Inc.
2.      Tirzepatide (Mounjaro) 7.5 mg	Eli Lilly
Equipment
1.      Blood pressure digital reader
2.      InBody Body Composition Analyzer		(Model: InBody 770)
3.      MetaCheck metabolic analyzer	Korr Medical Technologies
4.      Apple Watch
Software
1.      Epic, Electronic Health Record
2.   MyChart for communication